1 


CHILD  HEALTH  SURVEY 

630 

II  OF 

_  NEW  YORK  STATE 

o  ~°'. 

0  =  An   inquiry   into   the   measures   being   taken   in   the   different 

0  counties  for  conserving  the  health  of  children.   Conducted 

0  by   the   Child   Welfare   Committee   of  the   New    York 

3  State  League  of  Women  Voters. 

8 

9 
4 
9 


BY 

S.  JOSEPHINE  BAKER,  M.D.,  D.P.H., 

AND 
DOROTHY  C.  KEMPF,  A.B.,  M.D., 


LIBRARY 

FORNIA 
AKGKLES 


PUBLISHED   BY 

THE  NEW  YORK  STATE  LEAGUE  OF  WOMEN  VOTERS, 

Room   1625,   Grand   Central  Terminal   Building, 
New  York  City. 

1922. 
PRICE  FIFTEEN  CENTS 


A  CHILD  HEALTH  SURVEY 

OF 

NEW  YORK  STATE 


An    inquiry    into   the   measures    being   taken   in   the   different 

counties  for  conserving  the  health  of  children.    Conducted 

by   the   Child   Welfare   Committee   of  the   New   York 

State  League  of  Women  Voters. 


BY 

S.  JOSEPHINE  BAKER,  M.D.,  D.P.H., 

AND 
DOROTHY  C.  KEMPF,  A.B.,  M.D., 


PUBLISHED  BY 
THE  NEW  YORK  STATE  LEAGUE  OF  WOMEN  VOTERS, 

Room   1625,   Grand   Central  Terminal   Building, 
New  York  City. 

1922. 
PRICE  FIFTEEN  CENTS 


COMMITTEE  ON  CHILD  WELFARE 

OF  THE 
NEW  YORK  STATE  LEAGUE  OF  WOMEN  VOTERS 

S.  JOSEPHINE  BAKER,  M.D.,  D.P.H.,  Chairman. 

Miss  MARY  ARNOLD,  Vice-Chairman. 

MRS.  GORDON  NORRIE,  First  Vice-Chairman,  New  York  State 

-League  of  Women  Voters. 

DOROTHY  C.  KEMPF,  A.B.,  M.D.,  Executive  Secretary. 
Miss  ANNA  L.  SWORTS,  Field  Organizer. 


MRS.  HERMANN  M.  Bices 
MRS.  ABRAHAM  BIJUR 
MRS.  HENRY  DWICHT  CHAPIN 
MRS.  WILLIAM  H.  GOOD 
Miss  MABEL  CHOATE 
Miss  H.  IDA  CURRY 
MRS.  AUGUST  HECKSCHER 


Miss  SALLY  LUCAS  JEAN 
MRS.  F.  ROBERTSON  JONES 
MRS.  HERBERT  McCoY 
Miss  JEANIE  V.  MINOR 
Miss  HARRIET  ROGERS 
Miss  MILDRED  STEWART 
MRS.  FRANK  A.  VANDEHLIP 


CHAIRMEN  OF  COUNTY  COMMITTEES 

Albany  Miss   Elizabeth   M.  Smith,   Albany 

Allegany  Mrs.  Charles  Sisson,  Alfred 

Broome  Miss  Mary  Carter  Nelson,  Binghamton 

Cattaragus         Mrs.  Katherine  E.  Bradley,  Olean 

Mrs.   C.  H.  DeLisle,  Salamanca 
Cayuga  Mrs.  Fred  J.  Manro,  Auburn 

Chautauqua      Miss  Marian  Patterson,  Jamestown 

Mrs.  Joseph   Rieger,  Dunkirk 
Chemung  Mrs.  M.  Y.  Smith,  Elmira 

Clinton  Mrs.  W.  F.  Brown,  Plattsburg 

Mrs.  William  Levy,  Plattsburg 

Mrs.  W.  H.  Foote,  Plattsburg 
Columbia          Mrs.  Fred  Washburn,  Hudson 

Mrs.  Charles  Benson,  Hudson 
Delaware  Mrs.  Henry  White  Cannon,  Delhi 

Mrs.   Frank   McKinnon,   Sidney 


2O63771 


Dutchess 

Mr*. 

Miss 

Erie 

Miss 

Mrs. 

Mrs. 

Essex 

Mrs. 

Franklin 

Miss 

Fulton 

Mrs. 

Miss 

Genesee 

Mrs. 

Mrs. 

Miss 

Greene 

Mrs. 

Hamilton 

Mrs. 

Herkimer 

Mrs. 

Miss 

Livingston 

Mrs. 

Madison 

Mrs. 

Monroe 

Mrs. 

Montgomery 

Mrs. 

Mrs. 

Mrs. 

Mrs. 

Mrs. 

Mrs. 

Miss 

Nassau 

Mrs. 

Mrs. 

Mrs. 

Mrs. 

Niagara 

Mrs. 

Mrs. 

Miss 

Oneida 

Mrs. 

Miss 

Onondaga 

Mrs. 

Mis« 

Ontario 

Miss 

M.   C.  Woodruff,   Poughkeepsie 
Cleona  Class,  Poughkeepsie 
Elizabeth  Olmstead,  Buffalo 
George   Walters,   Williarasville 
Addison  F.  M.  Talbott,  East  Aurora 
George  Notman,  Keene  Valley 
Mary  F.  Pierce,  Moira 
R.  J.  Barnes,  Gloversville 
Bessie  Tibbets,  Johnstown 
James  Winne,  Elba 
Daniel  Mi-Cool,  Batavia 
Lucy  Hamilton,   Batavia 
Jessie  Vedder,   Cut-kill 
Laura  Peasley,  Indian  Lake 
Raymond  S.  Spears,  Little  Falls 
Jane  Boote,  Herkimer 
Agnes  D.  Roberts,  Geneseo 
P.  B.  Noyes,  Kenwood 
Bernard  F.  Dunn,  Rochester 
James  Conant,  Amsterdam 
N.  H.  Allen,  Sprakers 
N.  J.  Herrick,  Canajoharie 
C.  E.  Norton,  Fort  Plain 
C.  E.  Wagner,  St.  Johnsville 
A.  N.  G.  Freeman,  Charleston 
Maude  Hopkins,  Amsterdam 
Frederick  S.  Greene,  Port  Washington 
Forbes  Hawkes,  Port  Washington 
Hall  Marshall,  Garden  City 
Wm.  H.  Way,  Glen  Cove,  L.  I. 
A.  M.  Roaker,  Niagara  Falls 
C.  S.  Snow,  Niagara  Falls 
Olive  I.  Carter,  Lockport 
Samuel  T.  Bens,  Utica 
Isabel  Abelson,  Utica 
Burton   Michael,   Syracuse 
Marjorie  Trump,  Syracuse 
Mary  Gray  Peck,  Clifton  Springs 


Ontario 

Mrs. 

Orange 

Mrs. 

Mrs. 

Orleans 

Miss 

Oswego 

Mrs. 

Otsego 

Miss 

Putnam 

Mrs. 

Rensselaer 

Mrs. 

Rockland 

Mrs. 

St.  Lawrence 

Mrs. 

Saratoga 

Mrs. 

Miss 

Schenectady 

Mrs. 

Schoharie 

Miss 

Seneca 

Mrs. 

Steuben 

Mrs. 

Miss 

Suffolk 

Mrs. 

Sullivan 

Miss 

Miss 

Schuyler 

Miss 

Mrs. 

Tioga 

Miss 

Tompkins 

Mrs. 

Ulster 

Miss 

Warren 

Mrs. 

Miss 

Washington 

Mrs. 

Mrs. 

Wayne 

Mrs. 

Mrs. 

Westchester 

Mrs. 

Miss 

Mrs. 

Mrs. 

Mrs. 

Wyoming 

Mrs. 

Yates 

Mrs. 

H.  S.  Dunton,  Canandaigua 
F.  W.  Seward,  Goshen 
Mary  E.  Wait,  Newburg 
Ella  Bacon,  Albion 
Charles  S.  Wright,  Oswego 
Nina  V.  Short,  Oneonta 
Henry  de  Rahm,  Cold  Spring 
Duncan  C.  Kaye,  Troy 
Frank  Heubner,  Nanuet 
Robert  Ford,  Canton 
J.  J.  Dayton,  Corinth 
Katheryn  Starbuck,  Saratoga  Springs 
Edward   Everett   Hale,   Schenectady 
Ruth  Gordon,  Cobleskill 

D.  W.  Moran,  Seneca  Falls 
De  M.  Page,  Hornell 
Jeanette  McGregor,  Corning 
Frank  M.  Leavitt,  Smithtown 
Amelia  Greenwald,  Ellenville 
Erma  C.  Brenner,  Liberty 
Francis   McDowell,   Montour  Falls 
Vernona   Irena   Smith,  Watkins 

J.  Anna  Phillips,  Owego 

B.  F.  Lent,  Ithaca 

Grace  Roberts,  Highland 

W.  L.  Lawton,  Glens  Falls 

Marjorie  Bucknam,  Glens  Falls 

Willis  Mitchell,  Hudson  Falls 

Ida  A.  Hanna,  Cambridge 

J.  A.   Sanford,  Newark 

Charles  Ennis,  Lyons 

Daniel  O'Day,  Rye 

Estella  M.  Bogardus,  Yonkers 

Lawrence   Meade,   Tarrytown 

O.  K.  Lang,  Crestwood,  Tuckahoe 

E.  P.  Knapp,  Brier  Cliff 
A.  B.  Harding,  Castile 
Jerome   Ogden,  Penn  Yan 


CONTENTS 


Foreword:    How  the  Survey  was  Made. 
Introduction. 

PART  I.     THE  PUBLIC  SCHOOLS. 

1.  Evolution  of  Health  Problems  in  our  Schools. 

2.  Outline  and  Plan  of  School  Survey. 

3.  Condition  of  Buildings. 

4.  Medical  Inspection. 

5.  Health  Instruction. 

6.  Physical  Training. 

7.  Special  Classes. 

8.  Hot  Lunches. 

9.  Use  and  Supervision  of  Playtime. 

10.  Tables. 

1 1.  Summary. 

12.  Responsibility  of  Community. 

13.  Recommendations. 

PART  II.     PROVISIONS  FOR  MATERNITY  AND  INFANT  CARE 
-  THE  PRE-SCHOOL  CHILD 

1.  General  Considerations. 

2.  Maternity  and  Infancy  Hygiene  in  Individual  Counties. 

3.  Tables. 

4.  Summary. 

5.  Recommendations. 

Appendix  --  Medical  Inspection  Law. 


HOW  THE  SURVEY  WAS  MADE 

REPORT  OF  THE  CHAIRMAN  OF  ORGANIZATION 

For  those  who  are  especially  interested  in  the  details  of  or- 
ganization in  a  work  of  this  kind,  it  seems  desirable  to  give  a  brief 
account  of  the  methods  that  were  employed.  . 

The  survey  was  under  the  direct  supervision  of  Dr.  S.  Joseph- 
ine Baker,  Chairman  of  the  Child  Welfare  Committee,  and  Dr. 
Dorothy  C.  Kempf,  the  Executive  Secretary.  Both  Dr.  Baker  and 
Dr.  Kempf  had  the  technical  experience  and  background  requi- 
site to  conduct  such  a  widespread  scheme.  It  is  the  belief  of  the 
committee  that  similar  studies  ought  not  to  be  undertaken  in 
other  states  without  similar  competent  technical  direction.  Volun- 
teer work  on  a  large  scale  has  not  hitherto  always  shown  success- 
ful results  but  we  believe  in  this  instance  that  the  type  of  organi- 
zation that  was  carried  out,  both  in  the  central  office  and  in  the 
field,  made  it  possible  to  conduct  successfully  what  might  easily 
have  been  a  half-accomplished  project. 

Feeling  that  other  states  might  wish  to  follow  the  example  of 
New  York  State  in  finding  out  just  what  is  being  done  for  children 
within  their  borders,  it  seems  wise  to  outline  briefly  the  methods 
of  organization  that  were  employed  and  found  to  be  successful. 

The  subject  matter  of  the  questionnaires  was  carefully  thought 
out  at  the  central  office  and  was  prepared  under  the  technical 
supervision  of  the  Committee  and  received  its  approval.  The 
central  office  force  consisted  of  Dr.  Baker,  in  an  advisory  capa- 
city, Dr.  Kempf  as  executive  secretary,  Miss  Sworts  as  field  organ- 
izer and  one  stenographer,  working  in  close  cooperation  with  the 
Chairman  of  Organization  of  the  League.  The  latter  took  advan- 
tage of  the  already  organized  forces  of  women  within  the  State. 
A  few  temporary  organizers  were  employed  for  a  total  of  eight 
weeks.  Practically  all  of  the  work,  however,  was  done  by  the 
volunteers  in  the  field.  These  numbered  well  over  three  thou- 
sand. As  the  purpose  of  the  survey  was  not  only  to  determine 
the  extent  of  the  work  being  done  for  children  but  also  to  create 


a  localized  and  strong  public  opinion  which  could  be  utilized  in 
further  campaigns  for  child  welfare,  it  seemed  wise  to  make  the 
county  the  unit  for  the  gathering  of  statistical  information 
required. 

The  Committee  on  Organization  therefore  began  its  work  by 
writing  to  representatives  of  the  League  in  each  of  the  counties, 
outlining  the  plan  and  asking  them  to  undertake  the  work  of 
gathering  the  information  we  wished.  It  was  suggested  to  them 
that  a  local  committee  be  formed  which  should  include  represen- 
tatives of  all  of  the  women's  organizations  of  the  county.  54 
counties  out  of  the  total  of  57  included  in  the  state  were  officially 
organized  on  this  basis.*  In  this  organization  was  included  the 
active  co-operation  of  many  associations  of  women  who  were 
banded  together  for  some  type  of  civic  progress.  These  included 
the  Albany  City  Club,  Broome  County  Health  Association,  Cayuga 
County  Child  Welfare  Association,  Clinton  County  Red  Cross, 
Plattsburg  Civic  League — Educational  Committee,  Hudson  Wom- 
en's Club,  Women's  City  and  County  Club  of  Dutchess  County, 
Dutchess  County  Health  Committee,  Fulton  County  Parent  Teach- 
ers' Association,  Batavia  Women's  Club  Federation — Civic  Depart- 
ment, Herkimer  County  Tuberculosis  Committee,  Livingston 
County  Health  Committee,  Jefferson  County  Red  Cross,  Columbia 
County  Agency  for  Dependent  Children,  Fulton  County  Tubercu- 
losis Committee,  Little  Falls  Women's  Civic  Club,  Women's  Club 
of  Suffern,  Madison  County  Women's  Club,  Amsterdam  New  Cen- 
tury Club,  Fort  Plain  Mothers'  Club,  Saint  Johnsville  Community 
Club,  Montgomery  County  Charities  Aid  Association  Committee, 
Niagara  Falls  College  Club,  Utica  Civic  Club,  Oswego  Women's 
City  Club,  Nanuet  Civic  Club,  Lyons  Civic  Club,  Women's  Civic 
League  of  Troy,  Tioga  County  Home  Bureau,  Steuben  County 
Tuberculosis  Committee  and  Glens  Falls  Women's  Club. 

It  was  determined  to  begin  our  work  first  with  the  school 
questionnaire,  as  that  was  considered  the  simplest  and  most  direct 
at  the  time,  although  later  it  seemed  possible  to  us  that  the  ques- 
tionnaire on  care  of  infants  was  perhaps  the  easier  one  to  be  filled 
out.  The  first  step  was  to  find  out  from  the  State  Department  of 
Education  the  number  of  schools  in  the  state.  The  leader  in  each 
county  was  then  sent  a  sufficient  number  of  questionnaires  so 
that  each  school  could  be  covered  and  have  an  individual  question 

*The  counties  comprising  New  York  City  were  not  included  in  this  survey. 

10 


sheet  filled  out  for  it.  It  was  expected  that  the  leader  or  chairman 
of  the  county  committee  would  see  that  the  information  for  these 
sheets  was  obtained  by  members  of  the  committee,  working  indi- 
vidually or  in  small  groups,  and  only  in  exceptional  instances  was 
it  thought  either  legitimate  or  wise  to  have  the  questionnaires 
filled  out  by  the  teachers  or  principals  themselves.  This  was  par- 
ticularly necessary  in  order  to  achieve  our  desire  to  have  the 
women  become  interested  in  their  own  school  problems. 

When  the  questionnaires  were  filled  out,  a  special  form,  which 
was  in  effect  a  county  tabulation  sheet,  was  sent  to  the  chairman  so 
that  she  could  tabulate  her  own  returns  as  well  as  send  in  the 
individual  questionnaires.  In  this  way  the  work  of  the  central 
office  should  have  been  very  much  lessened,  although  it  may 
readily  be  understood  that  it  became  necessary  for  the  central 
office  to  check  up  the  county  tables.  We  believe,  however,  that 
this  system  has  value  because  it  makes  the  county  appear  as  a 
unit  and  gives  the  members  of  the  committee  in  that  county  a 
general  idea  of  the  whole  situation  rather  than  an  individual 
idea  of  the  single  school  that  each  member  may  have  visited. 
The  same  method  was  followed  in  the  case  of  the  second  question- 
naire. 

In  carrying  on  this  work  our  field  organizer,  Miss  Sworts, 
made  98  visits  to  the  various  counties  and  altogether  336  personal 
calls  on  individuals. 

The  first  questionnaire  did  not  get  fully  under  way  until  April, 
1921,  owing  principally  to  opposition  which  developed  in  the 
Department  of  Education,  due  to  a  quite  unnecessary  misunder- 
standing. We  were  obliged  to  assert  our  constitutional  right  to 
the  information  we  were  seeking.  We  allowed  a  month  for  the 
answering  of  these  questionnaires,  and  in  a  few  well  organized 
counties,  after  the  roads  were  open,  this  proved  sufficient.  As 
each  county  turned  in  75  per  cent,  or  more  of  its  questionnaires, 
we  returned  to  it  a  summary  of  results  for  that  county  in  a 
form  suitable  for  the  local  papers,  which  almost  without  excep- 
tion published  it.  We  did  this  by  means  of  a  mimeographed  form 
prepared  by  a  publicist,  which  required  only  the  filling  in  of 
figures  and  one  paragraph  relating  to  the  special  needs  of  each 
county.  When  about  forty  counties  had  reported,  an  article  was 
published  in  The  Woman  Citizen.  One  in  the  Review  of  Reviews 
followed  and  editorials  appeared  in  Good  Housekeeping  and  The 

11 


Woman's  Home  Companion.  We  distributed  2,000  copies  of  pre- 
liminary reports  (sent  to  helpers),  5,000  copies  of  conditions 
in  schools  distributed  at  fairs  and  1,000  reprints  of  preliminary 
reports  also  distributed  at  fairs,  all  of  which  was  part  of  the 
publicity  necessary  to  persuade  each  county  of  the  importance  of 
this  task.  Furthermore,  we  sent  speakers  for  26  meetings  (other 
meetings  were  held  by  local  chairmen  using  local  speakers) .  We 
exhibited  "The  Little  Red  School  House"  in  12  counties,  the 
period  of  time  being  from  two  to  six  days  in  each  county  with  a 
demonstration  approximately  three  times  a  day.  The  "Little  Red 
School  House"  was  a  "portmanteau  theatre"  suggested  by  Miss 
Sworts,  designed  and  constructed  by  Miss  Stella  Boothe,  and  given 
us  as  a  contribution  by  the  Child  Health  Organization  of  America. 
It  represents  a  rural  school  as  it  too  often  is,  and  as  it  should  be. 

During  the  summer  months,  while  the  schools  were  closed,  we 
took  up  the  second  questionnaire  in  the  same  manner.  17  coun- 
ties supplied  the  answers  without  assistance.  The  others  required 
a  personal  visit  and  the  work  was  completed  through  the  cooper- 
ation of  the  county  agents  of  the  State  Charities  Aid  Association. 
In  the  fall  when  the  schools  were  again  open  the  work  on  the 
first  questionnaire  was  continued  in  those  counties  which  had  not 
succeeded  in  covering  75  per  cent,  of  their  schools  before  they 
closed.  In  four  out  of  our  57  counties  we  were  unable  to  find  local 
organizations  which  would  undertake  the  work.  The  entire  sur- 
vey was  completed  in  one  year. 

Our  expenses  were  the  salaries  of  the  staff  already  mentioned, 
printing,  publicity,  and  certain  sums  in  a  few  counties,  never 
exceeding  $40.00  for  the  traveling  expenses  of  volunteers.  The 
other  counties  raised  what  they  needed  for  local  expenses.  The 
total,  including  preparation  and  printing  of  report,  was  $7,969.88. 
This  does  not  include  office  rent  or  equipment  or  the  stenographic 
work,  which  were  a  part  of  the  League's  contribution. 

It  is  an  extreme  gratification  to  the  committee  that  although 
there  seemed  to  be  no  special  precedent  for  a  survey  of  this  mag- 
nitude made  by  volunteers,  we  believe  it  to  have  been  accomplished 
successfully  and  we  also  hope  that  it  will  be  of  value  not  only  to 
New  York  State  but  to  all  of  the  other  states. 

The  generosity  of  our  subscribers,  the  interest  of  the  women 
of  New  York  State  in  the  welfare  of  the  children,  the  possibility 
of  having  technical  direction,  and  the  interest,  enthusiasm  and 

12 


competency  of  our  office  staff,  made  the  success  of  this  survey 
possible.  Two  benefits  are  plain:  first,  a  great  fund  of  informa- 
tion has  been  collected  at  very  small  expense;  and  second  and 
probably  far  more  important,  the  women  of  the  state  have  en- 
lightened their  communities  and  educated  themselves  as  to  the 
local  health  conditions.  In  this  way  and  to  this  extent  they  have 
fulfilled  the  highest  traditions  of  the  League  of  Women  Voters. 

MARGARET  NORRIE. 


INTRODUCTION 


In  the  late  fall  of  1920  the  New  York  State  League  of  Women 
Voters  decided  to  determine  the  conditions  affecting  the  health 
of  infants  and  conduct  a  state-wide  survey  of  children  in  the  State 
of  New  York.  It  was  known  that  there  was  a  state  law  requiring 
school  medical  inspection.  The  reports  of  the  State  Department 
of  Education  gave  evidence  of  their  intention  of  enforcing  this 
law.  Their  authority,  however,  apparently  did  not  extend  to 
creating  the  work  itself  in  places  where  it  was  needed.  The  law 
places  upon  the  local  communities  the  responsibility  for  employ- 
ing school  physicians  and  school  nurses.  The  meagre  reports  that 
could  be  obtained  from  the  rural  communities  seemed  to  show 
that  in  many  places  little  interest  was  taken  in  the  matter  by  the 
local  school  boards  and  that,  outside  of  the  large  cities,  there  was 
little  health  supervision  in  the  schools  that  was  worthy  of  tne 
name.  The  State  Department  of  Health  has  for  some  time  exer- 
cised a  limited  supervision  over  matters  pertaining  to  the  health 
of  mothers  and  babies.  It  was  evident,  however,  that  the  extent 
of  this  work  was  not  satisfactory  to  the  State  Department  of  Health, 
nor  was  it  meeting  the  needs  of  the  situation  that  seemed  to  exist. 
For  these  two  reasons  we  felt  justified  in  forming  a  committee 
with  the  object  of  determining  the  present  conditions  and  the 
needs  of  the  future  in  these  directions. 

The  present  widespread  awakening  of  interest  in  child  health 
has  come  from  two  main  sources:  first,  the  prominent  position 
given  child  welfare  work  in  Europe  during  the  world  war,  and 
second,  the  figures  of  the  draft  in  the  United  States,  showing  that 
approximately  40  per  cent,  of  the  young  men  of  this  country  were 
found  to  have  physical  defects  unfitting  them  for  active  service. 
It  seemed,  therefore,  that  a  large  women's  organization  such  as 
this  could  not  have  undertaken  a  more  patriotic  service,  one 
where  the  need  was  more  evident,  than  to  determine  the  exact 
status  of  the  health  care  of  children  in  one  of  the  states.  Legisla- 

15 


tion  affecting  the  health  care  of  children  is  undoubtedly  needed 
but  such  legislation  cannot  be  urged  until  the  present  status  of 
such  health  care  is  known  and  there  has  been  formed  an  intelli- 
gent body  of  public  opinion  to  urge  the  passage  of  the  proper  laws. 

Not  only  was  the  subject  matter  of  the  survey  of  the  greatest 
importance  but  it  marked  a  departure  from  similar  work  in  the 
past.  Studies  of  this  nature  have  usually  been  intensive  and  have 
required  the  expenditure  of  considerable  sums  of  money.  It  has 
been  felt  by  many  people  that  a  survey  made  entirely  by  volun 
teer  workers  would  be  neither  adequate  nor  conclusive.  The  task 
the  Child  Welfare  Committee  of  the  New  York  State  League  of 
Women  Voters  set  itself  was  to  carry  on  a  state-wide  survey,  using 
the  machinery  of  the  State  League  of  Women  Voters  and  depend- 
ing upon  volunteer  workers,  with  the  exception  of  a  few  paid 
employees  in  the  central  office.  The  Chairman  of  the  Committee 
on  Organization  of  the  League  has  prepared  a  statement  for  this 
report,  showing  how  the  survey  was  made. 

The  Committee  on  Child  Welfare,  which  was  responsible  for 
ihe  methods  to  be  used  in  making  the  survey,  had  in  mind  three 
objects:  first,  to  determine  the  exact  status  of  health  care  and 
health  work  for  babies,  young  children  and  children  in  the  public 
schools;  second,  to  make  many  women  in  every  part  of  the  state 
familiar  with  the  health  care  of  children  in  their  communities,  and 
third,  by  virtue  of  the  first  two  objects,  to  create  a  body  of  intelli- 
gent public  opinion  to  act  as  the  nucleus  of  a  force  to  obtain 
proper  health  care  for  the  children  of  the  state,  both  by  means 
of  state  legislation  and  local  community  action. 

The  Committee  on  Child  Welfare  feels  that  these  objects  have 
been  achieved.  The  survey  has  been  made  successfully  by  volun- 
teer workers.  The  women  who  visited  the  schools  have  in  many 
instances  for  the  first  time  learned  the  actual  conditions  surround- 
ing the  children  and  have  acquainted  themselves  with  the  neces- 
sary type  of  health  supervision  that  must  be  carried  on  if  the 
children  are  to  be  protected  in  an  adequate  manner  and,  probably 
most  important  of  all,  the  knowledge  thus  obtained  has  resulted 
in  the  creation  of  intense  interest  and  enthusiasm  for  bettering 
conditions.  Indeed,  it  may  be  said  that  the  effort  to  create  public 
opinion  has  had  a  more  far-reaching  effect  than  the  Committee 
expected.  Both  the  State  Department  of  Education  and  the  State 

16 


Department  of  Health  have  been  intensely  interested  in  the  work 
that  was  carried  on  and  it  is  not  too  much  to  assume  that  some 
of  the  progress  that  has  already  been  made  in  bettering  condi- 
tions since  this  survey  was  started  has  been  due  in  large  part  to 
the  efforts  of  the  League  and  the  information  it  has  gathered. 

Another  far-reaching  effect  has  been  the  stimulation  of  other 
states  to  carry  on  similar  work.  Certainly,  if  the  conditions  found 
to  exist  in  New  York  State  are  any  criterion,  the  necessity  for  a 
similar  survey  in  every  state  in  the  Union  is  apparent.  It  is  with 
the  hope  that  the  experience  of  New  York  State  in  this  regard 
may  be  of  some  aid  and  benefit  to  the  other  states  and  also  with 
the  belief  that  the  result  of  this  survey  will  mean  greater  protec- 
tion for  the  children  of  New  York  State,  that  this  report  is  sub- 
mitted. 

The  League  of  Women  Voters  of  New  York  State  consists  of 
an  earnest,  experienced,  active  and  intelligent  group,  which  has 
been  used  to  working  for  a  common  cause.  It  has  been  stated 
that  one  of  the  greatest  objects  of  any  investigation  to  determine 
the  responsibility  of  citizenship  must  be  the  stimulation  of  that 
group  of  citizens  to  better  effort  in  the  future.  Certainly,  a  sur- 
vey of  conditions  surrounding  babies,  young  children  and  child- 
ren in  the  schools  or  in  the  homes,  would  be  of  little  value  if  it 
resulted  solely  in  the  compilation  of  statistical  evidence  and  not 
in  the  betterment  of  conditions  when  changes  were  found  to  be 
desirable.  New  York  may  not  be  considered  a  typical  state  but 
certainly  it  must  be  considered  as  a  state  that  has  all  the  condi- 
tions that  wealth  and  a  place  of  assumed  leadership  can  give.  It 
may  readily  be  assumed,  therefore,  that  New  York  State  should 
give  all  of  its  children  the  fullest  measure  of  health  protection. 
It  should  provide  for  competent  and  effective  maternity  and  in- 
fant care  and  give  its  children  the  best  form  of  education  and  the 
best  form  of  school  medical  inspection  that  can  be  offered.  How 
far  it  has  achieved  such  a  goal,  and  how  far  it  has  fallen  short, 
it  has  been  the  effort  of  this  survey  to  disclose. 

S.  JOSEPHINE  BAKER, 

Chairman. 


17 


PART  I. 
EVOLUTION  OF  HEALTH  PROBLEMS  IN  OUR  SCHOOLS 

Until  recent  times  schools  have  been  thought  of  as  places  for 
academic  education.  It  is  only  within  the  last  twenty-five  years 
that  the  effect  of  school  life  upon  the  health  of  children  has  been 
considered.  We  have  become  increasingly  aware  of  the  fact  that 
there  is  probably  no  other  time  in  the  life  of  the  individual  when 
so  great  an  environmental  change  takes  place.  The  transition  from 
the  freedom  of  life  which  belongs  to  early  childhood  to  the  re- 
strictions and  routine  of  school  life  is  probably  the  most  sudden 
and  drastic  that  is  likely  to  occur.  To  take  a  child  five  or  six 
years  of  age,  when  it  is  passing  through  the  most  formative  period 
of  its  career  from  the  health  point  of  view,  a  time  when  all  child- 
ren are  usually  active,  when  they  are  the  personification  of  energy 
and  motion,  and  place  it  in  an  atmosphere  which  requires  atten- 
tion, concentration,  and  above  all  physical  quiet,  is  to  change 
habits  in  a  way  that  may  have  a  marked  bearing  upon  the  ques- 
tion of  proper  growth  and  bodily  welfare. 

Education  is  compulsory.  If  the  state  assumes  this  right,  tak- 
ing the  child  from  his  home  and  placing  him  under  the  authority 
of  the  state  or  local  community  for  certain  hours  of  the  day,  it 
should  certainly  be  also  the  right,  as  well  as  the  duty,  of  the  state 
to  provide  a  clean,  safe  and  hygienic  surrounding  in  which  the 
child  shall  spend  these  school  hours.  Certainly,  the  minimum 
requirements  in  the  way  of  health  conditions  must  be  met.  Noth- 
ing less  should  be  accepted  by  the  parents  of  this  country;  much 
more  should  be  demanded. 

School  hygienists  are  aware  of  the  large  part  that  school  envi- 
ronment plays  in  the  production  of  physical  defects.  Defective 
eyesight,  which  is  becoming  almost  universal,  is  distinctly  a  school 
disease.  Children  on  entering  school  rarely  have  defective  vision. 
Nearly  30  per  cent,  of  all  children  who  leave  school  are  com- 
pelled to  wear  glasses.  Here  is  an  instance  where  faulty  lighting, 

19 


bad  seating  accommodations,  insufficient  window  space,  wrong 
type  of  text  books,  dirty  blackboards  and  other  deficiencies  of 
school  life  are  responsible.  Curvature  of  the  spine  is  very  often 
the  result  of  the  wrong  type  of  seats  and  desks,  and  their  lack  of 
adjustment  to  the  individual  child.  Malnutrition  and  respiratory 
diseases  are  a  direct  outcome  of  lack  of  sanitation  and  result  more 
particularly  from  inadequate  ventilation  in  school  rooms.  Infec- 
tious diseases  are  so  common  an  accompaniment  of  school  life 
that  they  are  often  called  "school  diseases."  Epidemics  in  com- 
munities can  often  be  traced  to  infection  that  has  occurred  in 
school.  The  method  of  transmission  may  easily  be  the  common 
towel,  the  common  drinking  cup,  general  lack  of  personal  care, 
inadequate  ventilation  and  absence  of  health  supervision.  There 
are  few  harmful  bodily  conditions  to  which  the  child  is  subject 
that  may  not  have  their  inception  in  the  enforced  segregation  of 
school  life. 

School  medical  inspection  was  started  first  in  this  country  in 
Boston  in  1894.  It  was  entirely  concerned  with  the  detection  of 
infectious  diseases.  Philadelphia,  the  second  city  to  establish  this 
form  of  health  supervision,  in  1896,  followed  the  same  methods 
and  in  1897  New  York  City  was  the  third  city  in  this  country  to 
eee  the  possibilities  of  school  health  supervision  as  a  measure  for 
limiting  the  spread  of  infectious  diseases.  It  was  not  until  1905, 
however,  that  the  further  and  more  important  aspect  of  the  rela- 
tion of  the  school  to  health  was  emphasized.  At  that  time  the 
New  York  City  Department  of  Health  recognized  that  a  well- 
rounded  program  to  prevent  infectious  diseases  must  include  some 
consideration  of  the  general  health  of  the  child  and  its  power 
of  resistance  to  disease.  The  first  step  in  this  program  consisted 
in  the  institution  of  a  physical  examination  for  each  school  child 
to  determine  its  state  of  health  with  particular  reference  to  the 
existence  of  easily  preventable  or  as  easily  correctable  physical 
defects. 

School  health  supervision  or,  as  it  is  more  generally  known, 
school  medical  inspection,  has  assumed  a  wider  aspect  today  than 
was  thought  possible  by  the  early  workers  in  this  field.  We  have 
now  reached  the  place  where  the  health  supervision  of  the  child 
of  school  age  has  come  to  mean  complete  health  care  of  all  child- 
ren from  five  to  fifteen  years  of  age,  extending  not  only  into  the 

20 


school  but  into  the  home  as  well.  In  the  school  the  prevention 
of  the  spread  of  infectious  diseases  and  the  physical  examination 
of  each  school  child  are  simply  the  starting  point.  Health  instruc- 
tion and  physical  training  are  important  additions.  Various  forms 
of  specialized  activity  such  as  open  air  classes,  nutrition  clinics 
and  special  classes  for  children  with  cardiac  disease,  defective 
vision,  for  the  hard  of  hearing  or  those  who  are  crippled,  are 
becoming  a  recognized  part  of  the  school  health  program.  Health 
supervision  in  this  form  is  provided  for  by  legislation  in  the 
greater  part  of  the  United  States  today.  In  a  recent  bulletin  issued 
by  the  United  States  Public  Health  Service,  it  is  stated  that  thers 
are  a  total  of  29  states  which  have  some  laws  on  this  subject.  In  15 
of  these  states  the  Department  of  Education  and  the  Department 
of  Health  cooperate  in  the  administration  of  the  law.  In  six  states 
it  is  administered  by  the  Department  of  Education  and  in  eight 
states  by  the  Department  of  Health.  In  nine  states  with  medical 
inspection  laws  no  state  authority  is  designated  to  administer  the 
law  although  certain  duties  are  imposed  upon  the  local  authorities. 
In  three  states  authority  is  given  to  local  units  to  employ  public 
health  nurses.  In  nine  other  states  there  are  no  specific  laws 
regarding  school  medical  inspection  but  some  cities  have  instituted 
systems  of  school  medical  inspection  under  their  general  health 
powers. 

New  York  State  has  an  excellent  school  medical  inspection  law. 
There  are  ways  in  which  it  may  be  improved  but  as  it  stands  it 
includes  a  comprehensive  scheme  for  adequate  health  protection. 
Early  in  the  survey  it  was  found  that  the  fault  was  riot  with  the 
state  law  or  the  desire  for  its  proper  enforcement  by  the  State 
Department  of  Education.  It  became  increasingly  evident  that 
the  non-enforcement  of  the  principles  which  underlie  school  health 
supervision  was  due  not  to  inadequate  legislation  or  lack  of 
knowledge  of  its  principles,  but  rather  to  the  inertia  of  the  local 
educational  authorities. 

In  starting  the  health  survey  the  State  League  of  Women 
Voters  was  looking  for  definite  conditions  affecting  health.  They 
soon  found  themselves  forced  to  recognize  that  the  administration 
of  a  proper  health  program  could  not  be  effectively  carried  out 
unless  the  administration  of  the  regular  school  program  kept  pace 
with  it  and  was  mutually  cooperative.  One  of  the  most  striking 

21 


results  of  the  survey  has  been  the  clear-cut  impression  that  both 
the  educational  program  and  the  health  program  in  each  town- 
ship or  school  district  is  dependent  almost  entirely  upon  the  good- 
will and  interest  of  the  local  school  board  or  individual  trustees 
and  the  extent  to  which  they  are  swayed  by  public  opinion, 
it  was  found  that  however  extensive  or  earnest  the  education  or 
health  policy  of  the  state  might  be,  it  could  be  completely  blocked 
by  the  action  of  a  small  board  of  school  trustees  or  officials  who 
either  did  not  feel  that  they  could  afford  the  money  for  the  type 
of  work  in  question  or  who  did  not  see  any  reason  why  such  work 
should  be  carried  on  at  all.  Throughout  the  state,  the  women 
who  were  making  this  survey  were  forced  to  recognize  that  effec- 
tive health  work  was  impossible  in  some  communities  owing  to 
the  antiquated  system  of  innumerable  small  schools,  many  school 
districts  and  the  apparent  lack  of  any  willingness  to  cooperate 
that  might  lead  to  consolidation  and  improvement  of  conditions. 
It  is  obvious  that  school  medical  inspection  cannot  be  carried  on 
without  a  disproportionate  expenditure  in  schools  consisting  of 
three  pupils  or  even  ten  pupils,  yet  there  are  hundreds  of  such 
institutions  throughout  the  state,  as  may  be  seen  by  the  figures 
given  in  another  part  of  this  report. 

As  the  greater  part  of  the  appropriation  for  work  in  both  the 
education  and  health  fields  must  necessarily  be  provided  by  the 
local  community,  it  becomes  increasingly  evident  that  the  local 
community  must  be  the  'focus  of  attack  and  that  no  system  of 
health  supervision  or  education  can  rise  higher  than  the  level  of 
intelligence  of  the  local  community.  The  survey,  therefore,  was 
soon  brought  into  the  field  of  education,  not  so  far  as  the  course 
of  study  was  concerned,  but  in  so  far  as  the  administrative  fea- 
tures bear  upon  the  problems  that  we  were  considering.  It  may 
therefore  be  well,  before  outlining  the  exact  conditions  that  were 
found,  to  consider  briefly  the  evolution  that  has  taken  place  in 
the;  educational  field  in  New  York  State  and  to  indicate  what  the 
present  conditions  are  as  far  as  the  administration  of  the  schools 
is  concerned  and  their  relation  to  the  health  of  the  children. 

The  common  realization  that  the  system  of  education  in  this 
state  has  developed  so  tremendously  from  such  small  beginnings 
has  made  many  of  us  content  ourselves  with  a  feeling  of  satisfac- 
tion at  what  has  been  accomplished,  and  fail  to  see  that  great 

22 


as  the  advance  has  been  in  this  field,  it  has  failed  signally  to  keep 
up  with  other  lines  of  progress.  Especially  is  this  true  in  regard 
to  rural  education.  We  are  almost  unable  to  understand  the  point 
of  view  from  which  Herbert  Spencer  spoke  only  about  50  years 
ago,  when  he  argued  that  taxation  of  one  man's  property  to  edu- 
cate another  man's  children  was  robbery  and  that  the  state  had 
no  more  right  to  administer  education  than  it  had  to  administer 
religion.  We  have  admitted  the  responsibility  but  have  not  shoul- 
dered it  fully. 

New  England  developed  in  colonial  times  the  principle  of  a 
state  system  of  public  schools,  and  it  was  from  this  beginning  that 
the  typically  American  system  of  elementary  schools  grew;  the 
essential  features  of  this  system  being  that  the  schools  are  sup- 
ported by  taxation,  supervised  and  controlled  by  the  state,  and 
free  to  all  children.  The  fight  for  free  schools  in  the  different 
states  was  a  slow  and  painful  process  in  almost  every  case  because 
of  the  difficulty  in  educating  public  opinion.  Indiana  at  one  time 
passed  a  law  providing  that  "no  person  shall  be  liable  for  a 
tax  who  does  not  or  does  not  wish  to  participate  in  the  benefit  of 
the  school  fund."  In  commenting  on  this  fact,  Finney  in  The 
American  Public  School  quotes  one  of  the  assemblymen  as  orating: 
'"When  I  die  I  want  my  epitaph  written:  'Here  lies  an  enemy  of 
free  schools.' "  We  are  apt  to  wonder  at  the  shortsightedness  of 
such  people  with  a  distinct  consciousness  of  superiority,  quite 
failing  to  realize  that  we  are  just  as  shortsighted  today  in  regard 
to  the  needs  of  the  present  and  future. 

Our  school  district  system  was  established  in  1795  when 
the  inhabitants  of  settled  portions  of  the  state  banded  together 
for  the  purpose  of  maintaining  a  school,  and  in  1812  the  entire 
territory  of  the  state  was  organized  into  districts  and  a  State  Super- 
intendent appointed.  It  was  as  late  as  1853  that  the  Union  Free 
District  School  Law  was  passed,  and  it  was  not  until  1866  that 
New  York  state  made  all  of  her  public  schools  absolutely  free. 

School  systems  developed  in  the  same  manner  in  other  states 
but  they  soon  began  to  enlarge  the  unit  of  administration  and 
taxation  by  changing  from  a  district  to  a  township  system.  Indiana 
was  the  first  state  to  take  this  step  and  the  others  followed  rapidly. 
New  York  State  and  Louisiana  are  the  only  ones  left  in  which  the 
small  district  system  prevails.  This  system  is  recognized  through- 

23 


out  the  nation  as  resulting  in  inferior  administration,  wasteful 
expenditure,  unequal  taxation,  and  especially  in  unequal  school 
advantages.  In  a  recent  published  report  the  State  Department 
of  Education  gives  figures  to  show  that  the  per  capita  cost  of 
schooling  is  occasionally  nine  times  as  great  in  one  district  as  it  is 
in  an  adjoining  district  in  the  same  township.  The  same  report 
states  that  the  present  school  district  system  has  been  condemned 
by  every  state  superintendent  and  commissioner  of  education  from 
1844  up  to  the  present  time.  The  Hon.  Sam  Young,  state  super- 
intendent at  that  time  complained  that  "miserable  school  houses, 
poor  and  cheap  teachers,  interrupted  and  temporary  instruction, 
and  heavy  rate  bills  are  among  the  permanent  calamities  incident 
to  small  school  districts." 

At  the  present  time  every  township  has  anywhere  from  eight  to 
35  separate  school  districts.  In  1917  a  law  was  passed  in  the 
hope  that  it  would  alleviate  this  situation.  The  experience  of 
other  states  had  amply  demonstrated  the  greater  efficiency  of  a 
larger  unit  of  administration,  either  township  or  county,  and  no 
other  state  has  returned  to  the  small  district  system.  This  law, 
known  as  the  Township  School  Law,  made  the  town  the  unit  of 
administration  and  taxation,  and  gave  authority  to  the  town  Board 
of  Education  to  determine  whether  all  of  the  district  schools 
should  be  continued  or  whether  to  bring  about  a  consolidation 
among  certain  of  them.  The  immediate  result  of  this  law  was  an 
active  interest  in  school  conditions  on  the  part  of  the  new  town 
boards,  and  many  long-needed  repairs  and  improvements  were 
made.  This  was  simply  making  up  for  the  neglect  of  many  years, 
but  it  resulted  in  an  increase  of  about  20  per  cent,  in  the  school 
tax,  and  immediately  a  complaint  arose.  It  so  happened  that  a 
regulation  had  been  passed  requiring  all  schools  to  install  sanitary 
indoor  toilets  by  1918.  This  had  in  reality  nothing  to  do  with  the 
Township  School  Law,  but  it  added  to  the  burden  of  expense  in 
many  districts  and  was  associated  with  the  Township  Law  in  many 
people's  minds.  The  result  was  the  repeal  of  the  law  in  1918 
before  it  was  given  a  fair  trial.  There  was  a  great  deal  of  mis- 
apprehension on  the  part  of  the  general  public  in  regard  to  the 
provisions  of  the  law,  and  people  in  rural  sections  opposed  it  in 
the  fear  that  some  of  their  rights  and  powers  were  to  be  taken 
from  them  and  centralized  in  the  state.  The  actual  facts  in  regard 

24 


to  conditions  in  the  schools  and  their  great  needs  were  never 
brought  before  the  general  public  with  sufficient  vividness.  As 
a  member  of  one  of  the  town  boards  of  education  wrote  in  regard 
to  his  district  "Two  or  three  of  the  schools  are  hardly  better  than 
hog  pens — I  wish  the  people  of  the  state  could  see  them;  that 
would  settle  most  of  the  kicking."  The  people  of  the  state  did 
not  see  them,  and  were  not  convinced  of  their  needs. 

The  township  system  did  not  remain  in  existence  long  enough 
to  demonstrate  its  educational  advantages,  but  these  have  been 
amply  shown  in  other  states.  It  did  succeed  in  bringing  about  a 
temporary  improvement  in  sanitary  conditions  in  a  great  many 
schools. 

The  city  schools  were  originally  organized  on  the  district  sys- 
tem with  the  ward  forming  the  school  district.  The  inefficiency 
and  failures  of  this  system  were  recognized  during  the  middle  of 
the  last  century  and  they  were  met  by  consolidating  all  the  schools 
into  one  unit  of  administration  and  taxation.  The  first  city  super- 
intendent in  the  United  States  was  appointed  in  Buffalo  in  1837. 
Cities  in  other  states  immediately  began  to  adopt  this  system. 
Rochester  followed  in  1843,  Syracuse  in  1848  and  New  York  in 
1851.  The  step  in  each  city  was  preceded  by  a  bitter  fight  but 
this  period  is  long  since  over  and  the  result  is  the  far  more  efficient 
education  provided  by  our  city  schools. 

The  school  question  was  put  aside  during  the  period  of  the 
war,  but  it  must  now  be  brought  forward  again  for  the  need  of 
a  new  system  of  rural  education  in  this  state  is  urgent.  It  is 
important  in  viewing  the  whole  problem  to  keep  in  mind  the 
essential  need  of  adequate  education  and  proper  protection  of 
public  health  in  any  democracy  which  is  to  survive,  the  need  of 
qualifying  its  citizens  to  vote  intelligently  and  of  fitting  them  to 
live  in  health  and  efficiency.  And  it  is  necessary  to  realize  that 
the  tendency  in  this  country  which  has  brought  greatest  results 
has  been  that  of  enlarging  the  unit  of  administration  and  taxation 
in  order  that  more  equal  opportunity  will  be  provided  for  all 
children.  The  tendency  in  this  country  is  now  distinctly  towards 
the  county  unit.  State  aid  is  given  to  our  schools  for  many  pur- 
poses and  more  and  more  we  are  facing  the  need  of  having  the 
Federal  Government  share  in  the  educational  responsibility.  Such 
a  tendency  has  manifested  itself  in  the  Smith  Lever  Act  in  1914 

25 


which  provides  federal  aid  to  agricultural  colleges  and  in  the 
Smith  Hughes  Act  in  1917  which  gives  aid  to  vocational  educa- 
tion. This  is  a  simple  extension  of  the  principle  that  it  is  neither 
safe  nor  to  our  advantage  to  allow  any  family  or  community  to 
remain  ignorant  because  of  local  conditions  of  poverty  or  indiff- 
erence. 

Very  few  people  realize  that  we  still  have  left  throughout 
this  state  to  a  large  extent  and  in  practically  the  same  form  as 
in  early  days  what  is  affectionately  and  sentimentally  referred  to 
as  "the  little  red  school  house."  This  type  of  school  building  and 
the  training  it  provided  met  the  needs  of  agricultural  communities 
one  hundred  years  ago.  The  past  generation,  however,  has  seen 
a  great  change  in  methods  of  farming  resulting  from  the  applica- 
tion of  modern  machinery  and  biological  and  chemical  research. 
It  has  also  seen  a  fairly  extensive  migration  of  the  young  people 
from  farms  to  villages  and  cities,  and  one  of  the  causes  of  this 
desertion  of  the  farms  can  be  definitely  attributed  to  the  poor 
rural  schools.  At  one  time  the  three  R's  were  apparently  a  suffi- 
cient background  for  a  life's  work  in  any  field.  After  1835  geog- 
raphy, history  and  grammar  appeared  as  school  subjects.  The 
variety  of  subjects  needed  now  is  very  much  greater.  It  is  time 
for  the  rural  schools  to  adjust  to  this  new  development  so  as  to 
continue  not  only  to  fit  boys  and  girls  for  their  life  work,  but  to 
make  it  interesting  and  profitable. 

The  prime  requirement  in  a  school  should  be  a  well-constructed 
sanitary  building,  with  proper  equipment  and  sufficient  measures 
taken  to  conserve  the  health  of  the  children.  This  is  the  abso- 
lutely essential  foundation  for  building  up  a  generation  of  healthy 
and  efficient  adults,  and  it  is  with  this  phase  of  the  many  sided 
problem  of  education  that  this  report  chiefly  deals.  Thirty  years 
ago  the  school  assumed  no  responsibility  whatever  in  regard  to 
the  health  of  the  children  beyond  a  little  instruction  in  physiology 
and  even  here  the  practical  bearings  of  the  subject  were  largely 
neglected. 

There  has  been  developing  in  this  country  a  newer  attitude 
towards  physical  "fitness"  and  well  being.  We  are  more  and 
more  considering  mind  and  body  as  one  unit  and  seeing  the  need 
of  an  all  round  development.  The  swing  is  away  from  a  dualistic 
philosophy. 

26 


The  schools  have  held  a  prominent  place  among  the  interests 
of  public  spirited  individuals  from  their  beginning  and  school 
surveys  of  various  sorts  have  served  from  the  first  to  bring  their 
needs  before  the  general  public.  The  following  is  quoted  by  Judd 
in  The  Scientific  Study  of  Education  from  the  report  of  a  com- 
mittee appointed  to  visit  the  schools  of  the  township  of  Taunton, 
Massachusetts,  early  in  the  last  century:  "'Feb.  26th.  Visited 
Mr.  Dean's  school  two  times,  the  scholars  were  crowded  into  a 
small  room,  the  air  was  exceedingly  noxcious.  Many  children  were 
obliged  to  tarry  at  home  for  want  of  room,  and  though  the  school 
was  kept  only  a  few  weeks  they  were  deprived  of  its  advantages. 
A  want  of  books  was  the  complaint.  The  committee  were  anx- 
iously desirous  that  this  evil  might  have  a  remedy  and  were  of 
the  opinion  it  may  be  easily  done."  From  the  conditions  still 
prevailing  in  our  schools  it  is  to  be  feared  that  this  committee 
may  have  been  unduly  optimistic. 

OUTLINE  AND  PLAN  OF  SCHOOL  SURVEY 

Keeping  in  mind  the  fact  that  volunteer  investigators  were  to  be 
used,  many  of  whom  would  be  without  special  training  or  exper- 
ience in  this  sort  of  work,  the  questionnaire  covering  the  problems 
to  be  dealt  with  in  this  survey  was  drafted  with  a  good  deal  of 
care  so  as  to  avoid  as  far  as  possible  questions  involving  judgment. 
For  the  same  reason  sources  of  information  are  indicated  on  the 
questionnaire  and  an  occasional  explanation  of  a  question  or  state 
law  has  been  added  which  would  have  been  unnecessary  if  the 
questionnaire  had  been  designed  to  send  directly  to  the  teachers. 
The  latter  method  would  have  been  far  simpler  if  the  object  of 
the  survey  had  been  solely  the  collection  of  the  data,  but  one 
other  object,  that  of  bringing  the  schools  directly  into  the  line  of 
vision  of  the  communities  responsible  for  them,  would  not  have 
been  accomplished.  Very  frequent  answers  given  by  teachers  to 
the  question  "What  is  the  greatest  need  in  this  school?"  were: 
"interest  of  community"  and  "co-operation  of  parents".  In  a  small 
measure  this  piece  of  work  has  answered  and  is  still  answering 
this  need,  through  the  activity  of  our  local  committees.  It  is  one 
more  step  in  the  long  slow  process  of  educating  public  opinion. 

The  questionnaire  that  was  used  is  given  below.  It  is  divided 
into  seven  main  subjects:  medical  inspection;  health  instruction; 

27 


physical  training;  condition  of  buildings;  special  classes;  hot 
lunches;  and  use  and  supervision  of  play  time.  An  additional 
space  is  provided  for  special  needs  in  individual  schools.  The 
answers  to  this  series  of  163  questions  have  been  compiled  in 
Tables  I  and  II. 

QUESTIONNAIRE  NO.  I 
HEALTH  OF  THE  SCHOOL  CHILD 

(Please  read  the  entire  questionnaire  carefully  before  starting  to  answer  the 
individual  questions.)      Public  schools  only  are  included  in  this  investigation. 
Name  of  Invstigator? 
Address 

Name  of  school  visited? 
Supervisory  District? 
County? 
No.  of  children  attending? 

I.    MEDICAL  INSPECTION. 

1.  Is  a  physical  examination  made  of  every  child  who  does  not  bring 

a  health  certificate  from  the  family  physician? 
(The  law  requires  it  once  a  year.) 

a.  How  often? 

b.  In  what  school  grades? 

c.  How  much  time  is  given  to  examination? 

d.  Are  clothes  removed  to  the  waist? 

e.  Are  heart  and  lungs  examined  with  a  stethescope? 

f.  Are  reports  made  to  teachers? 

g.  Are  reports  made  to  parents? 

h.    Are  records  kept?  Where? 

i.     Are  notices  sent  to  parents  announcing  date  when  examinations 
will  be  made?  Are  they  invited  to  be  present? 

j.      Is  the  health  officer  employed  as  a  medical  inspector? 

Or  some  other  physician? 

k.    How  much  time  does  the  examiner  give  to  school  work? 
1.     What  is  the  examiner's  salary? 

m.    Is    a    thorough   physical    examination    made    before    working 
papers  are  given? 

2.  Are  class  rooms  visited  regularly  by  a  doctor  or  nurse? 

(Ask  the  teachers.) 

a.  How  often? 

b.  What  school  grades? 

c.  What  symptoms  are  noted? 

d.  Are  records  kept?  .  Where? 

3.  Are  eye  and  ear  tests  made  every  year?    (Ask  teachers.) 

a.    By  whom? 

4.  Is  there  a  school  nurse  for  your  district?     (See  nurse  if  possible.) 

a.    Full  time? 

(It  is  desirable  to  have  one  for  every  district  with  1000  or 
more  children.) 

28 


b.  Part  time? 

(1)     How  much  time  does  she  give  to  the  school  work? 

c.  How  much  supervision  does  she  have  from  the  State  Dept.  of 

Education? 

d.  Does  she  co-operate  with  the  teachers?     (Ask  the  teachers.) 

5.  Facilities  for  treatment. 

a.  Does  nurse  visit  children  in  homes  to  see  that  proper  care  or 

treatment  is  obtained? 

b.  Are  medical  and  surgical  clinics  available?      (Ask  nurse.) 

c.  Are  dental  clinics  available?     (Ask  nurse.) 

d.  Are  there  sufficient  facilities  for  treating  the  children? 

e.  What  proportion  of  children  needing  treatment  receive  it? 

f.  Does  the  follow  up  work  seem  to  be  satisfactory? 

(1)     In  what  way  does  it  fail?     (Ask  teacher  and  nurse.) 

6.  Communicable  diseases. 

(Ask  the  teacher  or  principal  for  the  answers.) 

a.  Is  a  physician  called  to  the  school  to  see  every  suspected  case? 

b.  Is  a  nurse  called  to  see  suspected  cases? 

c.  Does  teacher  report  all  suspected  cases  to  health  officer  when 

physician  is  not  called?     (The  law  requires  her  to  do  this.) 

d.  After    one    case    has    been    excluded    from    school    does    the 

medical  inspector  visit  the  school  daily  to  examine  the  other 
children?     Is  a  daily  visit  made  by  the  nurse? 

e.  Are  teachers  instructed  in  methods  of  early  diagnosis? 

f.  Are  teachers  provided  with  thermometers  and  taught  how  to 

sterilize  them? 

g.  Is    certificate    of    board    of    health    or    of    medical    inspector 

required   to   readmit   child   to   school?    (Required   by  law.) 

h.     Are  names  of  children  who  have  been  absent  from  school  for 
three  days  without  assigned  cause  sent  to  medical  inspector? 

i.     Has  it  been  necessary  to   close  the  school  for  any  epidemic 
during  1920?  What  disease? 

For  how  long? 

j.     Have  teachers  copies  of  the  chart  containing  "Rules  for  Isola- 
tion and  Exclusion  from  Schools"? 

k.    Is  Disease  Census  Card  filled  out  each  fall  by  parents? 

1.     Does  teacher  make  out  Susceptibility  Chart? 

(j,  k  and  1  are  issued  by  the  Dept.  of  Education.) 

II.    HEALTH  INSTRUCTION.     (Ask  the  teachers.) 

1.  Is  any  health  instruction  given? 

2.  In  what  grades  is  it  given? 

3.  Is  it  a  regular  pan  of  the  school  work? 

4.  Is  it  left  to  the  initiative  of  the  individual  teachers? 

5.  Is  instruction  given  by  the  school  nurse? 

a.    How  often? 

6.  Is   it  taught   as   a   separate   subject? 

7.  Is  it  taught  in  connection  with  other  subjects? 

8.  Is   the  importance   of  the  following   things  taught? 

a.  Long  hours  of  sleep  with  windows  open? 

b.  Cleanliness   of  person? 

c.  Brushing  teeth? 

d.  Clean  food  handled  by  clean  fingers? 

e.  Drinking  milk,  eating  green  vegetables  or  fruit? 

f.  Washing  hands  before  each  meal? 

g.  Covering  mouths  and  noses  when  coughing  or  sneezing? 

29 


9.     Are  under-weight  children  taught  the  necessity  of  rest? 
a.     Are  cots  provided  for  them? 

(1)  In   open  air? 

(2)  With  blankets? 

10.    Do  you  have  health  leagues  or  clubs? 

a.  Under  school  control? 

b.  Under  outside  control? 

c.  Are   they  effective   in   interesting   children  in  the   practice   of 

health  habits? 

11.  Have  you  had  any  health  exhibits?     This  includes  poster  contests, 

playlets,  etc.) 

12.  Ask  teacher  what  her  suggestions  are  for  improvement. 

13.  Is  there  any  method  used  for  checking  up  to  find  whether  children 

are   developing  health   habits? 

14.  Are  there  scales  in  the  school? 

a.     Are  children  weighed  regularly?  And  measured? 

Do  children  keep  a  class  room  weight  record? 
How  often  are  they  weighed? 
(Monthly  weighing  is  desirable.) 

(3)  Are  reports  sent  to  parents? 

(4)  Are  records  kept  in  the  school? 

III.  PHYSICAL  TRAINING.     (Ask  the  teacher.) 

1.  Is  there  an  instructor  in  physical  education? 

(There  are  800  in  the  State.) 

2.  Is  the  work  compulsory? 

3.  What  are  the  average  hours  a  week  required  for  each  child? 

4.  Is  a  physical  examination  made  before  allowing  child  to  enter  ath- 

letic contests? 

5.  Are  daily  exercise  periods  given  during  the  school  hours? 

a.  Number  of  minutes? 

b.  Are  windows  opened  wide? 

IV.  CONDITION  OF  BUILDING.     (These  questions  can  be  answered 

by  the  teachers,  but  it  is  desirable  for  the  investigator 
to  inspect  the  school  personally.) 

1.  Is  a  sanitary  survey  made  of  the  school,  its  equipment  and  rnainte 

nance  each  year? 
a.     By  whom? 

2.  How  often  are  class  rooms  cleaned? 

a.  How  satisfactory  is  this  cleaning? 

b.  Who  does  it? 

3.  What  is  source  of  water  supply? 

a.  Municipal? 

b.  Private  well? 

(1)     Is  its  purity  tested?  How  often? 

c.  Are  drinking  fountains  provided? 

d.  Are  there  individual  drinking  cups? 

4.  How  many  lavatories  are  provided? 

a.  One  for  how  many  children? 

b.  Are  there  individual  towels? 

5.  How  many  toilets  are  provided? 

a.  One  for  how  many  children? 

b.  What  kind?      (Outdoor  privy,  indoor  flush   closet.) 

c.  In  what  condition? 

30 


6.  What  is  the  average  number  of  children  in  a  class  room? 

a.  Is  there  any  evidence  of  overcrowding? 

b.  Is  a  desk  provided  for  every  child? 

7.  What   system   of  ventilation  is  used?      (Open  windows   or  artificial 

system.) 

a.  Are  windows  opened  wide  during  school  hours? 

(1)  How  often? 

(2)  For  how  long? 

(3)  During  recess? 

b.  Are  windows  opened  wide  before  school  hours? 

(1)     For  how  long? 

8.  Is  temperature  regulated  well? 

a.  Is  there  a  thermometer  in  each  room? 

b.  What  temperature  is  usually  maintained  during  winter? 

9.  Is  light  good? 

10.  Are  desks  adjusted  to  size  of  child? 

11.  Are  black  boards  a  good  clear  black? 

a.  Are  they  washed  daily? 

b.  Are  erasers  cleaned  daily?  How? 

V.  SPECIAL  CLASSES.      (The  teachers  can  give  this  information.) 

1.  Are  your  tuberculous,  mabiourished  or  anaemic  children  placed  in 

open  air  classes? 

2.  Are  your  backward  children  placed  in  special  classes? 

(The  law  requires  that  a   special  class  be  organized  when  there 

are    10    or    more    defectives.) 

a.     Is  the  school  equipped  to  test  the  mentality  of  the  backward 
children  ? 

(1)     How  many  children  are  behind  their  grade? 
b.     Has   the   Mental  Hygiene   Service   of  the   State  Department   of 
Education  been  asked  to  test  backward  children? 

3.  Are  there  any  other  special   classes?      (Sight  conservation,  cardiac, 

crippled.) 

VI.  HOT  LUNCHES. 

1.  Are  hot  lunches  provided? 

a.  Free? 

b.  At  cost? 

2.  Are  lunches  available  for  all  children? 

3.  Do  the  children  help  to  prepare  the  school  lunch? 

4.  Are  only  undernourished  children  given  lunches? 

5.  What  proportion  of  children  go  home  for  lunch? 

6.  What  proportion  of  children  bring  their  lunches? 

a.     Is  a  hot  drink  or  dish  provided  for  these  children? 

VII.  USE  AND  SUPERVISION  OF  PLAY  TIME. 

1.    Is  there  a  playground  connected  with  the  school? 

a.  Is  it  well  equipped?  Large  enough  for  baseball? 

b.  Is  it  much  used? 

c.  Are  games  taught? 

(1)  By  whom? 

(2)  Are   school   entertainments   encouraged? 

a.  Dances? 

b.  Plays? 

31 


c.  Clubs? 

(1)  Boy  scouts? 

(2)  Girl  scouts? 

(3)  Camp  fire  girls? 

(4)  Any  others? 

d.  Who  supervises  the  entertainments? 

VIII.     WHAT  IN  YOUR  OPINION  ARE  THE  GREATEST  NEEDS  IN  THIS 
SCHOOL? 

a.     Do  these  needs  apply  to  other  schools  in  this  district? 

In  making  up  the  tables  showing  the  facts  brought  to  light  by 
this  questionnaire  it  was  necessary  to  adopt  certain  definite  stand* 
ards.  To  say  that  a  careful  medical  examination  is  made  may 
mean  little  or  much;  it  all  depends  upon  the  standard  used.  So 
the  following  explanation  of  our  method  of  evaluating  the  effi- 
ciency of  an  individual  school  is  quite  essential.  In  no  instance  has 
a  failure  to  answer  a  question  been  interpreted  as  meaning  a  lack 
of  the  facility  inquired  about,  although  it  often  seemed  probable 
that  this  was  the  case.  Our  figures  represent  actually  positive  or 
negative  answers,  not  failures  to  answer,  and  for  this  reason  we 
believe  that  they  represent  conditions  as  being  really  better  than 
they  are.  Often  we  were  not  able  to  classify  schools  in  certain 
respects  because  our  data  were  insufficient.  In  particular  was  this 
so  in  regard  to  the  medical  inspection.  In  classifying  a  medical 
examination  as  satisfactory,  we  required  that  an  average  of  10 
minutes  should  be  given  to  each  child  in  rural  sections,  and  6 
minutes  to  each  child  in  large  city  schools  where  the  assistance  of 
nurses  and  the  development  of  a  regular  routine  is  possible.  We 
required  that  the  heart  and  lungs  should  be  examined  with  a 
stethescope,  that  eye  and  ear  tests  should  be  made  (not  neces- 
sarily by  the  physician)  and  that  records  should  be  kept.  Many 
of  our  questionnaires  came  back  with  an  indefinite  answer  to  the 
time  requirement  such  as  "sufficient"  or  "very  little."  We  have 
included  none  of  these  in  our  tables. 

We  classed  a  school  as  showing  very  little  interest  in  health 
problems  if  there  were  neither  health  clubs  nor  exhibits,  if  the 
children  were  not  weighed  more  often  than  once  a  year,  and  if 
no  method  was  adopted  to  determine  whether  or  not  the  children 
were  forming  health  habits.  If  any  one  of  these  points  was 
positive  we  gave  the  school  the  benefit  of  the  doubt  and  did  not 
class  it  as  showing  very  little  interest  in  health  problems. 

32 


In  determining  whether  to  class  a  building  as  excellent,  fair  or 
poor  in  respect  to  its  sanitary  conditions,  we  considered  the  fol- 
lowing points:  cleanliness,  water  supply,  individual  drinking  cups 
or  fountains,  lavatory  facilities,  individual  towels,  number  and  con- 
dition of  toilets,  overcrowding,  ventilation,  light,  type  of  desk 
and  condition  of  blackboards.  It  was  impossible  to  make  our 
standards  absolute  in  this  class.  In  the  first  place,  we  had  almost 
as  many  investigators  as  there  were  schools  investigated,  and  while 
we  made  our  questions  as  specific  as  possible,  we  had  to  accept 
their  judgment  as  to  whether  a  toilet,  for  instance,  was  in  satis- 
factory condition  or  not.  We  have  given  some  of  the  specific 
findings  in  Table  II.  The  figures  in  Table  I  on  the  subject  of 
buildings  represent  our  estimate  formed  after  a  consideration  of 
these  and  other  details.  Many  factors  had  to  be  considered  in 
making  these  judgments.  For  instance,  while  we  consider  out- 
door toilets  of  the  soil-polluting  type  undesirable,  we  have  not 
classed  rural  schools  possessing  such  toilets  as  poor  in  regard  to 
their  sanitary  conditions  unless  these  toilets  were  neglected.  Simi- 
larly, the  necessity  of  carrying  water  from  a  neighbor's  well  is  an 
undesirable  feature  in  general,  but  with  a  school  of  five  or  six 
children  and  the  distance  not  great,  it  cannot  fairly  be  considered 
an  unsanitary  condition.  With  a  school  of  20  children  and  the 
nearest  well  half  a  mile  away,  it  may  with  perfect  justice  be  con- 
sidered an  unsanitary  condition.  Borderline  cases  have  to  be  esti- 
mated in  connection  with  the  total  of  the  rest  of  the  sanitary  find- 
ings. We  do  not  feel  that  our  judgments  are  at  all  severe,  and 
have  consistently  given  the  school  the  benefit  of  the  doubt. 

The  other  items  require  no  special  explanation  with  the  excep- 
tion of  the  one  entitled  "Needing  better  playgrounds  or  equip- 
ment." No  schools  with  less  than  15  pupils  were  included  in  this 
class,  for  we  felt  that  it  would  be  more  desirable  for  most  of  them 
to  consolidate  with  adjacent  districts,  rather  than  to  go  to  the 
expense  of  properly  equipping  themselves. 

CONDITION  OF  BUILDINGS 
1.  CITY  AND  VILLAGE  SCHOOLS 

The  rapid  growth  of  many  of  our  cities  has  brought  about  a 
situation  that  is  in  urgent  need  of  solution.  It  has  resulted  not 
only  in  crowding  buildings  beyond  their  maximum  capacity  but 

33 


in  putting  children  on  part  time  schedules,  and  placing  them  in 
undesirable  annexes.  The  boards  of  education  have  in  many 
cases  been  trying  for  years  to  secure  the  necessary  funds  for 
proper  development,  but  without  success.  In  some  instances  delay 
has  been  justified  because  of  the  high  cost  of  building  during  and 
following  the  war,  but  it  must  also  be  remembered  that  the  Boards 
of  Estimate  and  Apportionment,  who  must  give  their  sanction, 
have  many  requests  put  before  them  and  not  infrequently  con- 
sider other  city  needs  as  more  urgent  than  the  education  of  the 
children. 

Moreover,  many  school  buildings  which  were  well  constructed 
in  the  first  place  have  been  improperly  cared  for  and  unsanitary 
conditions  have  developed  because  of  carelessness  or  failure  to 
make  necessary  repairs.  The  artificial  systems  of  ventilation  seem 
particularly  vulnerable.  Whether  they  are  too  complex  for  the 
intelligence  of  the  average  janitor  or  inherently  faulty,  we  have 
not  the  data  to  determine  but  we  found  that  they  were  frequently 
out  of  order.  The  toilets  in  modern  well  built  schools  are  also 
sometimes  improperly  cared  for  and  permitted  to  get  out  of  order 
but  they  are  usually  sufficient  in  number  and  in  fair  or  good 
condition.  It  is  the  situation  in  regard  to  overcrowding  which  is 
most  serious  in  the  larger  cities.  Annex  after  annex  has  been 
rented,  many  of  them  very  unsuitable,  and  classes  are  held  in 
basements,  cloak  rooms,  under  insufficient  artificial  light,  and 
with  poor  ventilation. 

In  Buffalo  about  10,000  children  of  elementary  school  age  are 
being  taught  in  attic  rooms,  cellars,  cloak  rooms,  rented  quarters 
and  annexes.  Many  of  these  are  lighted  by  gas.  Nineteen  large 
schools  had  no  assembly  room  and  eleven  playgrounds  are  needed. 
The  Board  of  Education  estimates  that  it  will  take  twelve  new 
schools  to  care  for  the  overcrowding.  Many  of  the  old  buildings 
also  need  repairs  and  several  were  found  in  a  very  unsanitary 
condition. 

In  Rochester  a  large  number  of  schools  reported  overcrowding, 
although  the  school  equipment  itself  is  usually  good.  Practically 
all  schools  provide  individual  towels  in  their  lavatories  and  mod- 
ern drinking  fountains,  and  reported  that  the  toilets  were  in  good 
condition.  The  schools  do  not  all  have  adjustable  desks.  One 
reported  that  the  desks  were  old  and  that  blocks  were  used  for 
resting  the  feet  of  small  children.  Several  have  no  assembly  halls 

34 


and  nine  playgrounds  are  needed.  In  one  school  with  an  attend- 
ance of  over  600  the  children  have  to  stand  in  the  street  before  the 
doors  are  opened,  since  there  is  no  yard.  A  building  program  is 
planned  for  the  next  three  years  at  an  estimated  cost  of  $10,000,000. 
If  this  policy  is  carried  out  the  city  will  be  brought  up  in  its 
school  needs  to  the  point  where  the  war  halted  development.  At 
the  present  time  the  same  evils  of  overcrowding  found  in  so  many 
of  our  large  cities  are  present,  with  half-time  sessions,  lessons 
studied  and  classes  held  in  corridors  and  temporary  annexes. 

To  enumerate  the  needs  in  each  city  is  unnecessary  here.  In 
general  they  are  very  much  the  same  and  result  from  a  period  of 
failure  to  expand  because  of  the  high  cost  of  labor  and  materials 
incident  to  the  war.  The  urgent  need  is  the  popular  support  of 
the  building  programs  presented  by  the  Boards  of  Education. 

The  following  quotations  from  some  of  our  large  city  ques- 
tionnaires give  a  picture  of  the  sort  of  conditions  found.  These 
were  in  answer  to  the  last  question  "What  in  your  opinion  are 
the  greatest  needs  in  this  school?" 

1140  children.  "The  school  is  made  up  of  7  buildings  scattered  over 
4  square  miles.  There  are  2  fairly  good  buildings.  The  rest  are  make- 
shift annex  buildings  in  stores  and  churches.  A  new  building  is  planned 
here  which  will  provide  everything,  and  that  seems  very  remote." 

"A  school  building.  All  children  housed  in  5  different  frame  annexes, 
some  of  them  exceedingly  unsatisfactory." 

665  children.  "Has  drinking  fountains  only  in  boys'  basement.  The 
building  is  lighted  by  gas.  There  are  no  individual  cups  or  towels, 
and  no  playground." 

"A  lunch  room  for  children,  a  rest  room  for  teachers,  an  addition 
to  building  that  will  ease  present  overcrowded  condition.  Give  us  a 
gymnasium  and  assembly  room.  An  elementary  school  to  care  for 
about  400  children  who  are  housed  in  church  and  an  unsanitary  port- 
able annex." 

936  children.  "Assembly  room,  Paint!  class  rooms,  gymnasium,  play, 
ground,  screens!  Garbage  and  paper  and  flies.  City  dumping  ground 
nuisance.  1000  gulls  feed  here." 

Annex.  "An  old  building  heated  with  drum  stoves,  poorly  lighted. 
Children's  wraps  hang  in  storm  sheds,  freeze  when  wet.  Many  people 
send  children  to  private  schools  because  of  poor  condition  of  annex." 

"Additional  room  to  prevent  the  use  of  rented  annexes  and  old  school 
building  that  should  have  been  abandoned  years  ago.  Two  hundred 
children  now  on  half  time  should  have  full  time.  Teachers  of  foreign 
children  should  have  smaller  classes  and  more  time  for  individual 
work." 

35 


572  children.  "No  entertainments  because  no  grounds  and  no  assembly 
room.  Needs  room  enough  to  teach  the  children  of  the  district.  Greatest 
need  is  cleanliness." 

1000  children.  "A  decent  assembly  hall.  Electricity  for  lighting  (one- 
half  the  building  is  lighted  by  gas).  Some  provision  made  for  cleaning 
the  windows — this  is  not  janitor's  work,  I  am  told.  Some  windows  are 
never  cleaned,  evidently." 

374  pupils.  "A  shower  bath  for  the  boys  and  girls.  An  electric  cleaner 
and  attachment.  10  dozen  home  made  handkerchiefs  (a  great  need) 
about  6"  square.  School  yard  put  in  condition  for  proper  play  space, 
also  to  eliminate  mud  and  dirt  in  classrooms." 

660  pupils.  "An  auditorium,  more  playground,  playground  equipment ; 
a  gymnasium.  A  special  teacher  for  backward  children." 

"Everywhere  I  have  investigated  I  have  found  janitors  and  children 
sweeping  and  raising  clouds  of  dust." 

As  a  rule  the  village  schools  do  not  suffer  from  overcrowding 
as  is  the  case  in  so  many  city  schools  and  many  of  those  classed 
as  excellent  were  found  in  this  group,  especially  in  suburban 
regions.  In  most  of  these  schools  sanitary  conditions  are  good  and 
playgrounds  are  provided  with  a  certain  amount  of  equipment. 
The*  problems  in  urgent  need  of  solution  are  not  found  in  this 
group. 

2.  RURAL  SCHOOLS. 

There  are  10,236  rural  schools  in  this  state,  and  8,600  of  these 
consist  of  one  room  buildings  only.  These  are  usually  simple 
frame  structures  with  windows  on  both  sides,  which  are  heated  by 
a  stove,  often  unjacketed,  which  produces  a  very  uneven  temper- 
ature. It  has  been  estimated  that  54  per  cent,  of  these  schools  are 
50  years  old  or  more,  and  that  13  per  cent,  have  been  in  existence 
for  75  years.  Some  date  back  to  1812. 

The  latest  figures  on  attendance  available  from  the  Depart- 
ment of  Education  are  as  follows: 

15     schools  had  an  average  attendance  of     1     pupil 
52  "          "     "         "  "  "     2     pupils 

1  ,    -  tt  it          it  U  U  ..          O  ti 

2  eg         "          "     "         "  «  ••      i  « 

QQ9  "  "          "  *'  "  U  r  44 

This  makes  a  total  of  885  rural  schools  having  an  average  of 
5  or  leas  pupils. 

36 


430  had  an  average  attendance  of     6     pupils 


556 
535 


This  makes  a  total  of  3,015  schools  which  had  an  average  attend- 
ance of  less  than  10  pupils.   This  is  42  per  cent,  of  all  rural  schools. 


(This   photograph    was    supplied    through    the    courtesy    of    the    State    Department    of    Education) 

1.     One  of  our  rural  schools. 

The  reason  for  such  a  condition  is  to  be  found  in  the  fact  that 
the  school  district  is  an  area  2  miles  square,  and  the  resistance 
of  the  community  towards  putting  improvements  into  schools 
which  serve  so  few  children  is  easy  to  understand.  It  is  also 
obvious  that  such  schools  do  not  as  a  rule  attract  efficient,  well 
trained  teachers.  Finney  goes  as  far  as  to  say  that  the  little  one 
room  school  is  "a  disgrace  to  any  progressive  farm  community." 
We  feel  that  there  are  still  communities  in  this  state  which  must 
continue  to  use  such  buildings,  but  they  certainly  do  not  number 
anywhere  near  8,000;  modern  road  building  and  the  motor  bus 
have  made  the  old  system  no  longer  necessary.  As  a  rule  there  is 
very  little  community  interest  in  these  schools.  The  trustees  are 

37 


elected  chiefly  for  their  ability  to  keep  the  taxes  low,  and  urgently 
needed  repairs  and  equipment  are  put  off  from  year  to  year.  The 
teachers  rapidly  become  discouraged  because  of  lack  of  materials 
to  work  with,  and  almost  every  year  it  becomes  necessary  to  secure 
a  new  one. 

The   following    quotations   from   our   questionnaires   illustrate 
rather  vividly  the  needs  in  many  of  these  schools: 

"We  need  a  new  roof,  every  time  it  rains  we  have  to  move  around 
to  get  out  of  the  rain.  The  class  room  was  not  cleaned  at  all  this 
year.  There  is  no  thermometer  and  the  heat  is  not  well  regulated. 
It  was  too  warm  in  front  and  too  cold  in  the  back  of  the  room." 

"School  house  cleaned  at  least  once  a  year  thoroughly;  necessary 
equipment  such  as  broom  and  dustpan.  Suitable  seats  installed;  cleaner 
toilets;  better  floors  and  have  them  oiled." 

"Someone  to  sweep  the  floor  at  least  once  a  week;  a  drinking  foun- 
tain; a  receptacle  for  erasers,  which  are  allowed  to  remain  on  the  floors 
or  on  the  window  sill  or  on  the  teacher's  desk.  The  toilets  are  in 
poor  condition." 

"A  new  building.  Our  present  building  is  nothing  less  than  a  dis- 
grace to  the  community.  Also  better  physical  examination." 

"Inside  of  the  building  made  over.  This  includes  new  blackboards, 
good  walls  painted  a  light  color,  new  desks.  Girls'  and  boys'  toilets 
separated  with  at  least  a  partition.  Ashes  and  coal  bin  removed  from 
front  door." 

"New  blackboards;  windows  that  can  be  opened;  a  stove  which 
can  be  regulated." 

"We  need  a  new  floor  and  desks;  if  floor  could  be  oiled  it  would 
help  much.  We  need  playground  helps,  also  inside  toilets,  new  black- 
boards and  new  window  curtains." 

"2  or  3  in  one  seat;  water  is  carried;  toilets  are  poor;  temperature 
is  not  regulated;  desks  are  not  adjusted;  light  is  poor;  blackboards 
are  poor;  school  has  been  condemned  for  years." 

"We  need  a  water  fountain,  new  desks,  a  new  floor  and  a  lock  on 
the  school  house." 

"Some  school  buildings  are  nothing  but  barns,  never  improved,  but 
still  children  spend  better  part  of  day  in  them." 

"New  floor,  new  doors,  better  method  of  lighting  the  school  room, 
maps.** 

"Stove  badly  needed,  no  means  of  ventilation,  no  playground;  school 
should  be  kept  cleaner." 

"Something  done  to  settle  dust.  The  floor  is  such  that  by  walking 
over  it  dust  is  raised.  A  new  flag  is  also  needed." 

"School  cleaned  more  frequently  and  floor  oiled." 

"Better  floor  which  could  be  oiled  and  would  be  of  some  use." 

"Key  lost  from  one  door  (locked).  Another  door  knob  broken, 
leaving  only  two  exits  free  in  case  of  fire." 

38 


"A  drinking  fountain,  a  clock,  a  map  of  the  United  States,  a  library 
case,  some  readers  for  children  from  first  to  fourth  grade." 

"In  my  opinion  the  greatest  need  of  the  school  is  an  oiled  floor. 
As  it  is  much  dust  is  flying  through  the  air  all  the  time." 

"Additions  built  on.  There  are  33  children  with  15  double  seats. 
Very  small  space  for  more  seats.  A  flag." 

"Our  greatest  need  is  a  new  school  house." 

"There  should  be  a  thermometer  in  the  room.  The  room  is  equipped 
with  double  seats,  some  of  which  are  broken.  Single  seats  would  be 
a  great  improvement." 

116  pupils.  "A  new  building  with  class  rooms  enough  so  that  it 
will  not  be  necessary  for  a  teacher  in  the  High  School  to  go  outside 
the  building  to  hold  classes  in  the  study  hall  where  there  are  many 
distractions  open  to  all  concerned." 

"Whole  town  needs  better  school  buildings." 

"Black  boards  are  small,  poor  black,  very  poorly  placed;  toilets  are 
cold  and  unsanitary;  desks  and  seats  do  not  fit  the  children.  Greatest 
need  is  for  new  blackboards  and  some  better  system  of  ventilation. 
School  is  heated  by  wood  stove." 

"Method  of  cleaning  school  room  to  avoid  dust,  either  oiling  of 
floor  and  use  of  oiled  mop,  or  weekly  scrubbing  with  soap  and  water 
not  by  teacher." 

"This  school  is  in  bad  repair  and  is  therefore  very  hard  to  keep 
clean.  It  also  needs  books  more  than  almost  any  school  I  have  visited." 

"A  door  knob,  a  latch,  —  an  American  flag." 

"Drinking  jar,  oiled  floor,  windows  on  a  pulley  to  open  from  top 
and  bottom  and  stay  where  they  are  placed;  outside  painted;  new 
individual  desks." 

"The  seats  are  old  and  rickety." 

"I  taught  in  this  school  27  years  ago;  it  is,  with  a  few  minor 
changes,  practically  unchanged.  To  get  to  the  school  room  you  pass 
through  outer  room  containing  the  fuel,  broom,  dustpan,  etc." 

"This  school  has  the  usual  entry  through  the  wood  shed." 

"A  forlorn  appearance  inside  and  out.    Much  needed  improvements." 

"A  chimney  that  doesn't  smoke,  a  stove  that  warms  the  room,  clean 
walls,  desks,  floor,  maps,  dictionary  and  other  necessities  for  proper 
work."  (23  children  in  this  room). 

"School  house  in  poor  repair  outside  and  in;  large  hole  in  front 
of  building,  near  roof,  large  enough  to  admit  rain  and  snow,  and  plenty 
of  cold  in  winter." 

"This  building  was  very  poor,  built  low  to  ground  near  creek  and 
leaky  roof.  (Trustee  had  mender,  the  worst).  The  teacher  was  very 
young  and  lacked  initiative  in  knowing  what  to  ask  for.  The  play- 
ground was  absolutely  bare  and  no  games,  not  even  balls  provided." 

It  is  encouraging  occasionally  to  find  the  following:  "The  building 
has  been  condemned  by  the  State  Department  of  Education,"  but  they 
keep  on  using  it,  however. 

39 


"One  school  in  this  second  district  is  closed  because  there  were  only 
2  pupils.     I  understand  these  two  are  not  in  school  at  all,  as  the  district 
is  remote  and  children  too  young  to  send  elsewhere." 
"Screens.     In  fall  the  place  is  full  of  flies." 
"The  ramshackle  stove  should  be  junked." 

Sanitary  Survey.  It  is  one  of  the  regulations  that  a  sanitary 
survey  should  be  made  of  each  school  every  year,  and  61  per  cent, 
reported  that  this  had  been  done.  There  is  no  uniform  system  in 
complying  with  this  requirement,  and  it  is  frequently  omitted 
or  made  by  the  teacher  alone.  In  22  per  cent,  of  the  schools  that 
we  investigated  no  survey  had  been  made  and  17  per  cent,  left  the 
question  unanswered.  Some  district  superintendents  make  these 
surveys,  but  not  all  district  superintendents  visit  their  schools  each 
year.  The  sanitary  survey  is  occasionally  made  by  the  school 
physician,  and  at  other  times  by  a  trustee. 

Cleaning.  The  usual  rural  school  is  cleaned  once  a  year,  some- 
times not  as  often  as  that,  and  during  the  rest  of  the  tune  it  is 
swept  or  mopped  by  the  teacher  or  pupils.  Cleaning  was  stated 
to  be  unsatisfactory  in  579  schools. 

One  of  the  most  frequently  mentioned  needs  in  small  schools 
was  oil  for  the  floors,  and  teachers  told  our  investigators  that  it 
was  very  difficult  to  get  the  trustees  to  supply  this;  that  they  had 
paid  no  attention  to  numerous  requests.  The  dust  and  powdered 
chalk  in  these  schools  is  simply  stirred  up  by  dry  sweeping  in 
many  cases,  and  a  large  percentage  settles  again  in  the  room.  Occa- 
sionally the  school  equipment  does  not  even  include  a  broom. 

Lighting.  In  most  of  the  one-room  school  houses  windows  are 
placed  in  both  side  walls  in  such  a  way  that  cross  lights  are  pro- 
duced. It  is  well  recognized  that  for  any  prolonged  work  which 
requires  writing  the  light  should  come  from  the  left  side  only, 
otherwise  the  shadow  of  the  hand  interferes  to  a  considerable  ex- 
tent with  the  clear  vision  of  the  paper,  and  the  constant  movement 
of  this  shadow  is  trying  for  the  eyes.  Not  only  does  the  light  often 
come  from  the  wrong  direction  but  in  many  cases  it  is  actually 
insufficient,  sometimes  because  of  too  many  trees  around  the  build- 
ing, sometimes  because  the  windows  are  too  small  and  the  interior 
walls  of  a  dark  color  and  occasionally  because  of  simple  neglect 
indicated  by  the  remark  "windows  never  washed  apparently". 
Eleven  per  cent,  of  the  schools  that  were  investigated  complained 
of  poor  light.  This  by  no  means  includes  all  those  in  which  there 
are  cross  lights  or  in  which  the  light  conies  from  the  wrong 

direction.  An 

40 


Blackboards.  These  are  another  source  of  serious  eye  strain. 
About  half  of  them  are  wooden  and  the  black  paint  wears  off  in  a 
short  time,  leaving  a  surface  that  is  hard  to  write  on  and  hard  to 
read  from.  932  schools  (22  per  cent.)  were  reported  as  having 
blackboards  in  this  sort  of  condition.  They  are  seldom  washed, 
because  this  helps  to  remove  the  surface.  Sometimes  there  are  no 
erasers,  sometimes  the  chalk  rail  is  missing. 

Desks.  The  old  double  desk  and  seat  is  still  usually  found  in 
rural  schools.  It  does  not  always  mean  that  two  children  are 
actually  using  these  desks  because  the  number  of  children  in  many 
of  the  schools  is  so  small  that  a  large  number  of  desks  are  unoccu- 
pied. 1179  schools  (28  per  cent.)  were  unable  to  give  their  chil- 
dren desks  of  the  proper  size.  This  does  not  mean  that  all  of  the 
other  schools  had  modern  adjustable  desks,  for  in  many  cases  it 
simply  meant  that  there  were  so  many  more  desks  than  children 
that  all  could  be  fairly  well  fitted.  546  schools  (13  per  cent.) 
reported  having  two  children  in  one  seat,  and  a  few  have  had  to 
put  three  in  one  seat.  The  latter  sort  of  overcrowding  is  very 
rare  in  country  schools  however.  The  opposite  condition  is  much 
more  common  and  schools  built  to  accommodate  20  or  30  children 
have  only  10  or  12  actually  in  attendance. 

Water.  The  water  supply  varies  greatly,  and  comes  from  all 
sorts  of  sources.  Many  schools  have  no  water  on  their  own 
grounds,  and  the  children  have  to  carry  it  in  pails  from  a  neigh- 
bor's well,  or  a  nearby  spring  or  brook.  888  schools  (23  per  cent.) 
reported  having  to  carry  their  water,  and  it  is  not  always  from  a 
nearby  source.  In  most  cases  the  distance  was  not  stated,  but  one 
school  with  22  pupils  had  to  go  a  quarter  of  a  mile  for  water,  and 
another  with  11  pupils  had  to  carry  it  half  a  mile.  Others  reported 
the  difficulty  in  terms  of  time  instead  of  distance  as  "it  takes  20 
minutes  to  go  for  our  water".  A  few  schools  reported  having  no 
water  at  all.  Where  there  is  a  well  on  the  school  grounds  it  is  fre- 
quently the  open  type,  and  its  purity  has  very  rarely  been  tested. 
The  state  provides  facilities  for  the  free  testing  of  water  but  they 
are  seldom  taken  advantage  of.  Water  is  kept  in  the  school  rooms 
in  an  open  pail  with  simply  a  dipper  or  single  cup  for  drinking 
purposes  in  altogether  too  many  schools.  474  (11  per  cent,  of  all 
schools  visited,  including  both  city,  union  free  and  rural  schools) 
had  neither  drinking  fountains  of  any  sort  nor  individual  cups. 
The  real  percentage  of  unsanitary  drinking  arrangements  is  un- 

41 


doubtedly  higher  because  in  many  of  the  schools  which  reported 
having  individual  drinking  cups  the  children  simply  keep  their 
own  cups  in  their  desks  and  dip  them  into  the  common  pail.  Our 
questionnaire  unfortunately  does  not  distinguish  these  from  the 
others,  and  so  they  are  all  classed  with  the  satisfactory  group. 
Some  of  the  needs  in  regard  to  water  were  expressed  as  follows: 

"A  sanitary  water  cooler,  cups,  towels,  pure  water  —  at  least  some- 
thing besides  creek  or  surface  water." 

"Spring  should  be  improved." 

"Neighbor's  well  should  be  tested." 

38  children.     "Water  used  from  open  spring." 

"Children  bring  bottles  from  home." 

"The  water  has  to  be  carried  a  long  way.  If  running  water  could 
be  installed  the  children  would  keep  cleaner,  the  building  would  be 
cleaned  better  and  life  more  livable." 

"Sink  for  washing  hands  as  there  is  plenty  of  water  near  by  for 
that  purpose.  Children  go  to  a  near  by  brook  often  when  weather  is 
warm." 

"There  should  be  a  jar  with  faucet  for  water  instead  of  open  jar, 
and  a  closet  or  sanitary  place  for  keeping  drinking  cups." 

"A  definite  source  of  good  drinking  water  is  one  of  the  most  needed 
things  in  District  School  No.  6." 

22  pupils.  "Good  water  supply  needed  —  sometimes  in  winter  go 
without  water." 

46  pupils.  Water  supply  is  "a  brook,  polluted,  and  water  carried 
one  quarter  of  a  mile  for  drinking  purposes." 

159  pupils.     "No  water  supply." 

48  pupils.  "Water  obtained  from  neighbor's  well  when  in  working 
order." 

82  pupils.  "An  investigation  or  water  supply  —  some  question  of 
purity  of  it.  Pupils  annoy  neighbors  to  get  drinking  water." 

One  high  school  with  300  pupils  reported  having  no  lavatory 
facilities  except  one  bowl  under  the  drinking  fountain.  No  sani- 
tary survey  had  been  made,  the  toilets  were  in  bad  condition,  the 
ventilation  poor.  There  was  no  auditorium  and  no  playground 
equipment. 

One  school  with  190  children  had  no  water  supply  at  all, 
either  for  drinking  or  lavatory  use.  Its  two  outdoor  toilets  were 
in  poor  condition,  and  no  sanitary  survey  had  been  made. 

Lavatory  arrangements  in  the  typical  one-room  school  consist 
of  a  basin  with  a  common  towel  or  none  at  all.  Very,  very  rarely 
are  paper  towels  supplied.  Occasionally  some  of  the  children 
bring  towels  from  home  and  keep  them  in  their  desks  for  varying 

42 


lengths  of  time.  Sometimes  there  is  "a  towel  for  each  family." 
In  the  union  free  districts  it  is  quite  common  to  find  paper  towels 
provided  and  regular  lavatories  with  running  water.  Among  the 
rural  schools  visited  26  per  cent,  reported  having  no  lavatory 
facilities  and  47  per  cent,  of  all  schools  had  no  individual  towels. 
Toilets.  Our  investigation  shows  that  55  per  cent,  of  the  rural 
schools  investigated  still  have  outdoor  privies.  It  is  frequently 
argued  that  the  children  going  to  such  schools  come  from  homes  in 
which  any  other  form  of  toilet  is  unknown.  Such  a  point  of  view 
fails  to  comprehend  the  real  function  of  the  school  in  relation  to 
the  community.  It  is  indicated  in  the  following  incident  quoted 
from  E.  E.  Davis  in  Thq  Twentieth  Century  Rural  School:  "A  fly 
proof  sanitary  toilet  with  a  cement  floor  was  observed  at  a  country 
home.  It  was  an  exact  copy  of  the  one  at  school.  The  proprietor 
of  the  home  said  'Yes,  that  boy  of  mine  thought  the  one  at  school 
was  a  good  thing.  Then  he  and  I  built  this  one.'  Now  there  are 
seven  others  just  like  it  in  use  at  the  country  homes  in  that  dis- 
trict." 

The  State  Department  of  Education  passed  a  regulation  a 
number  of  years  ago  requiring  that  all  outdoor  privies  should  be 
replaced  by  some  type  of  sanitary  indoor  toilet.  This  require- 
ment was  to  be  fulfilled  in  1918,  but  it  roused  so  much  local  feel- 
ing that  it  was  not  pressed.  Here  is  an  example  of  the  need  of 
educating  public  opinion  to  support  progressive  measures.  It 
is  the  opposite  of  the  autocratic  system  and  the  one  upon  which 
we  must  necessarily  depend  in  this  country.  Although  the  process 
is  slower  and  more  expensive  it  results  in  the  end  in  real  support 
of  the  measure  instead  of  antagonism.  The  law  in  this  country 
against  spitting  in  public  buildings  and  street  cars  undoubtedly 
owes  much  of  its  enforcement  to  the  campaign,  carried  on  largely 
by  the  Tuberculosis  Societies,  which  has  had  as  its  object  the 
education  of  the  public  in  regard  to  the  danger  of  spreading  dis- 
ease. The  general  public  supports  this  law  because  it  understands 
the  reason  for  it.  A  similar  campaign  carried  on  in  rural  sections 
which  would  present  the  unhygienic  features  of  the  outdoor  privy 
is  an  essential  complement  to  any  regulation  providing  for  its 
removal. 

Separate  toilets  are  always  provided  for  boys  and  girls  but 
they  are  sometimes  under  the  same  roof  with  a  simple  partition 
between.  Walls  are  scratched  up  with  obscene  words  and  a  gen- 

43 


eral  appearance  of  neglect  is  common.  587  toilets  (13  per  cent.) 
were  described  on  the  questionnaires  as  being  in  poor  condition. 
Flies  breed  in  these  toilets  and  swarm  to  the  school  houses  which 
are  unscreened.  Conditions  are  very  much  better  in  the  schools 
which  have  installed  chemical  toilets.  Only  occasionally  was  one 
of  these  reported  in  poor  condition.  Water  closets  were  usually 
reported  as  in  fair  or  good  condition  except  in  the  very  large 
schools  where  an  insufficient  number  had  been  installed.  Some 
of  the  needs  in  regard  to  toilets  are  quoted  below: 

School  with  200  pupils.  "Drainage  connected  with  sewer  —  it  now 
flows  into  the  creek." 

96  pupils.  "The  greatest  needs  of  this  school  are  indoor  toilets, 
gymnasium  and  assembly  room." 

"Two  separate  toilets  —  there  is  one  with  partition." 

"Toilet  paper." 

"Odor  from  toilet  unbearable"   (school  of  18  pupils). 

"Some  periodic  cleaning  and  disinfecting  of  outdoor  privies  — 
usually  dene  but  once  a  year." 

"The  outdoor  toilets  are  within  10  feet  of  the  school." 

"Toilets  frozen  for  four  months  and  could  not  be  used."  (30  pupils 
in  the  school) . 

"A  partition  between  boys'  and  girls'  toilets." 

"The  outdoor  privy  is  the  worst  feature  due  to  abuse  by  young 
toughs  in  the  neighborhood,  and  also  to  neighbors  who  use  it  as  a 
dump.  Locks  have  been  brcken  in  the  past.  The  teacher  trains  the 
children  not  to  use  it  unless  absolutely  necessary." 

"The  outdoor  toilets  have  received  no  attention  in  more  than  a 
year,  and  the  interior  walls  of  both  outbuildings  were  decorated  with 
obscene  carvings." 

312  children.    "Outdoor  toilets  in  poor  condition. 

"Suitable  toilets,  for  they  face  one  another  and  are  not  separated 
by  a  fence." 

"The  toilets  are  even  harmful  to  good  health." 

"Some  improvements   in  toilets  are  badly  needed." 

"Toilets  should  be  fixed  so  the  flush  will  work." 

"Chemicals  fail  to  work  properly.    Odor  offensive  in  the  summer.'* 

114  pupils.  "Not  enough  toilets.  Need  of  disinfectant.  The  seats 
in  girls'  toilets  all  broken." 

250  children.     "Outdoor  toilets  in  poor   condition." 

Heating  and  Ventilation.  These  subjects  have  to  be  considered 
together.  With  the  simple  unjacketed  stove  placed  in  the  center  or 
near  the  front  of  the  school  room,  it  is  of  course  impossible  to 
maintain  anything  like  an  even  temperature,  and  such  schools  are 
frequently  exceedingly  uncomfortable  in  winter.  The  children 

44 


near  the  stove  are  too  hot  and  those  in  the  outskirts  of  the  room 
are  too  cold.  800  schools  (19  per  cent.)  reported  that  they  were 
unable  to  regulate  the  temperature  with  any  degree  of  satisfac- 
tion. It  is  impossible  to  give  any  definite  figure  in  regard  to  the 
usual  temperature  maintained  in  these  rooms  during  winter  be- 
cause 36  per  cent,  of  them  have  no  thermometers,  and  even  with 
a  thermometer  it  will  register  quite  different  figures  in  different 
parts  of  the  room.  Sometimes  it  is  kept  on  the  teacher's  desk, 
sometimes  hung  on  a  wall,  sometimes  suspended  from  the  ceiling. 
One  school  reported  a  temperature  varying  from  40  to  90  degrees. 
One  teacher  said:  "We  keep  warm  after  two  hours  in  the  morn- 
ing." Undoubtedly  this  is  not  an  isolated  instance.  A  picture 
of  conditions  in  these  schools  is  given  by  the  following:  "We  are 
thankful  if  there  is  enough  warmth  to  begin  school  at  nine.  With 
windows  opened  it  would  be  impossible.  I  believe  in  fresh  air 

but  come  to Hill.     School  has  ventilation 

through  cracks.  Windows  would  freeze  us."  [We  keep  it]  "hot 
as  possible."  Many  times  on  the  questionnaire  the  need  of  new 
stoves  was  simply  mentioned  among  other  needs  and  a  number 
of  new  chimneys  were  asked  for. 

Although  these  schools  are  so  cold  early  in  the  morning  they 
frequently  become  very  hot  before  the  end  of  the  day,  and  in 
spite  of  the  air  coming  through  door  and  window  frames  and 
the  side  walls,  there  is  far  from  sufficient  ventilation.  To  quote 
from  a  few  questionnaires: 

"Heating  system  poor  —  in  severe  weather  school  closed." 

"Temperature   cannot  be  raised  above  40  degrees   on  some  days." 

"Windows  will  not  open  from  the  top." 

"Windows  frozen  down  in  winter." 

"Pulleys  for   windows.     Will  not   stay   open   where  put." 

45  children.  "Impossible  to  use  thermometer  in  cold  weather. 
Those  near  stove  too  hot  —  those  back  too  cold." 

"Smoke  poured  out  between  loosened  bricks  in  the  chimney  peri- 
lously near  the  shingled  roof." 

"Have  to  climb  on  desks  to  open  windows." 

"Windows  cannot  be  lowered  from  top." 

"This  is  a  district  school  away  out  in  the  country  and  of  course 
there  are  all  kinds  of  things  needed,  but  it  seems  to  me  the  most 
important  one  of  all  is  better  ventilation.  The  windows  are  nailed 
for  winter,  and  if  one  removes  the  nails  the  windows  fall  out." 

"Windows  adjusted  so  they  can  open." 

37  children.    "Temperature  varies  from  40  to  90  degrees  in  winter." 

"Extension  of   chimney  to  keep  stove  from  smoking." 

45 


Educational  Equipment. — No  questions  were  asked  in  regard 
to  maps  or  books,  but  the  need  of  this  sort  of  equipment  was 
mentioned  so  often  as  a  note  at  the  bottom  of  our  question- 
naire that  the  need  cannot  be  dismissed  without  a  word.  One 
teacher  in  asking  for  books,  papers  and  magazines  wrote: 
"These  children  are  simply  starved  for  something  to  read.  They 
read  the  most  trashy  things.  Oh,  for  some  good  reading  mat- 
ter!" Others  stated  that  although  there  were  books  in  the  school 
library,  they  were  beyond  the  understanding  of  most  of  the 
pupils.  From  one  county  alone  we  received  seven  of  these 
spontaneous  remarks  in  regard  to  a  lack  not  of  library  books 
but  of  text  books  for  children  who  could  not,  or  whose  parents 
would  not  provide  them.  One  teacher  told  our  investigator 
that  the  children  were  often  backward  merely  through  a  lack 
of  books,  adding,  "I  think  text  books  should  be  provided  for  every 
child."  The  futility  of  maintaining  a  school  and  requiring 
attendance  and  then  failing  to  provide  text  books  would  indeed 
seem  obvious.  The  need  of  a  school  library  may  not  seem  as 
obvious,  but  it  is  almost  as  great.  Reading  matter  for  children 
in  rural  homes  is  exceedingly  meager,  and  the  usual  school  library 
is  soon  exhausted.  At  the  time  in  life  when  the  first  interest  in 
reading  appears  the  material  is  not  at  hand,  the  opportunity  is 
lost  and  the  habit  is  not  formed.  It  is  not  our  intention  to  go 
further  into  the  question  of  educational  equipment,  but  the 
appeals  were  so  frequent  and  came  so  often  from  schools  which 
showed  at  the  same  time  poor  sanitary  conditions  that  the  prob- 
lem could  not  be  passed  over  without  mention.  It  makes  all  the 
more  urgent  the  need  of  some  form  of  reorganization  in  our  rural 
school  district  system  which  will  tend  to  abolish  these  very  small 
schools  which  are  so  often  not  only  unsanitary  but  poorly  equipped 
from  the  educational  standpoint,  expensive  and  inefficient. 

MEDICAL  INSPECTION 

Requirements  of  the  Law.  The  medical  inspection  law  for  New 
York  State  was  passed  in  1913.*  It  provides  for  an  annual  exam- 
ination of  all  school  children,  and  for  the  remedial  care  of  those 
suffering  from  disease  or  physical  defect.  The  State  Department 
of  Education  is  intrusted  with  the  responsibility  of  seeing  that  its 
provisions  are  fulfilled,  and  the  Commissioner  may  withhold  pub- 
*See  Appendix  p.  134. 

46 


lie  money  from  a  district  which  wilfully  refuses  or  neglects  to 
comply  with  the  rules  and  regulations  laid  down  under  the  law. 

Cities  of  the  first-class,  Buffalo,  New  York  and  Rochester,  are 
not  affected  by  this  law,  and  the  health  supervision  of  their 
schools  is  a  function  of  their  respective  boards  of  health. 

The  law  requires  that  every  school  child  should  have  a  sepa- 
rate and  careful  examination  including  eye  and  ear  tests  every 
year,  and  provides  for  the  appointment  of  school  physicians  to 
make  these  examinations  in  all  cases  where  children  do  not  bring 
health  certificates  signed  by  some  other  licensed  physician.  It  is 
also  the  duty  of  the  medical  inspector  to  provide  relief  and 
treatment  for  those  children  whose  parents  or  guardians  are  unable 
or  unwilling  to  do  so. 

The  law  provides  that  nurses  may  be  employed  in  the  same 
manner  as  the  physicians  or  jointly  employed  by  several  districts, 
and  the  State  Department  of  Education  recommends  that  there 
should  not  be  more  than  2000  children  under  the  care  of  one  nurse. 
The  medical  inspectors  are  also  empowered,  but  not  required,  to 
examine  teachers,  janitors  and  school  buildings,  when  in  their 
opinion  this  is  necessary  for  the  protection  of  the  children. 

Medical  Inspectors.  The  school  medical  inspectors  are  ap- 
pointed by  the  boards  of  education  in  cities  and  union  free  school 
districts,  and  by  the  trustees  of  common  school  districts,  and  the 
expense  is  met  through  the  funds  raised  by  the  regular  school  tax. 
The  work  is  usually  done  on  a  salary  basis  in  the  larger  communi- 
ties, and  at  a  definite  sum  per  child  in  the  rural  sections.  The  most 
frequent  amount  given  is  fifty  cents  for  each  examination.  Some 
medical  inspectors  are  paid  a  dollar  for  each  child,  and  some  only 
twenty-five  cents.  As  a  general  rule  the  community  gets  about 
what  it  pays  for,  although  occasional  physicians  make  careful 
examinations  for  very  little  recompense. 

Full  time  inspectors  are  employed  in  Albany,  Amsterdam, 
Buffalo,  Lockport,  Poughkeepsie  and  Rochester. 

In  many  cases  the  regular  health  officer  is  appointed  school 
physician  also,  and  whether  or  not  he  holds  this  position,  he  has 
a  certain  responsibility  in  regard  to  the  schools  in  connection 
with  the  control  of  communicable  diseases,  his  certificate  or  ap- 
proval of  the  certificate  of  the  family  physician  being  required 
before  a  child  can  be  readmitted  after  an  absence  due  to  one  of 
these  diseases.  This  provision  is  complied  with  in  the  majority 

47 


of  schools.  All  schools  are  supposed  to  contain  charts  entitled 
"Rules  for  Isolation  and  Exclusion  from  Schools,"  but  these  were 
frequently  missing.  On  the  whole,  there  is  better  provision  for 
the  control  of  communicable  diseases  than  there  is  for  discovery 
and  correction  of  physical  defects  which  are  no  less  serious. 

Physical  Examinations.  All  but  82  schools  out  of  the  4,244 
investigated  complied  with  the  law  in  providing  some  sort  of  physi- 
cal examination,  but  only  38  per  cent,  of  these  were  carefully 
made.*  39  per  cent,  consisted  of  a  very  cursory  inspection  and  in 
16  per  cent,  no  eye  and  ear  tests  were  made.  It  is  a  quite  common 


(Courtesy  of  the  Child  Health  Organisation) 
2.    Now  is  the  time  to  discover  and  remedy  defects — Building  for  the  future. 


*In    7  per   cent,   the   clothes    were   removed   to   the   waist. 

48 


finding  that  physical  examinations  are  more  carefully  made  in  the 
districts  which  employ  nurses  to  attend  to  the  follow  up  work  and 
it  is  easy  to  understand  why  this  should  be  so.  The  physician  feels 
that  his  work  is  worth  while  because  it  will  produce  results.  It 
cannot  fail  to  be  discouraging  to  examine  a  group  of  children  each 
year  and  send  recommendations  to  their  parents,  and  find  every 
succeeding  year  that  no  attention  has  been  paid  to  them. 

Nurses.  Practically  all  city  schools  have  the  services  of  a  nurse 
and  many  are  visited  regularly  by  nurses  at  least  every  month  and 
often  every  week,  but  it  is  very  exceptional  for  rural  schools  to 
have  this  service.  Of  the  villages  which  are  union  free  districts 
82  per  cent,  have  one  or  more  nurses.  69  per  cent,  of  all  the  schools 
investigated  (including  both  urban  and  rural  schools)  were  never 
visited  by  a  nurse,  12  per  cent,  received  an  occasional  visit  (usu- 
ally once  a  year)  and  15  per  cent,  were  visited  regularly  as  often 
as  once  a  month.  In  Rockland  County  53  per  cent,  of  the  schools 
were  visited  regularly.  This  was  the  highest  average  found,  but 
in  Schoharie  County  there  is  not  a  single  school  nurse.  A  number 
of  counties  employ  one  nurse  who  includes  visiting  the  schools 
among  her  other  duties.  She  is  never  able  to  reach  all  of  the 
schools  in  a  given  year,  and  seldom  visits  an  individual  school 
more  than  once. 


(Courtesy  of  the   Child  Health   Organisation) 

3  and  4.    The  monthly  weighing  of  all  children  checks  up  in  a  prac- 
tical way  the   results   of  the   health   instruction. 

Dental  Service.  Dental  attention  is  particularly  difficult  to  ob- 
tain because  the  majority  of  parents  do  not  realize  the  importance 
of  it  and  pay  no  attention  to  the  recommendations  made.  Only 
with  dental  clinics  easily  accessible  and  school  nurses  to  get 

49 


directly  in  touch  with  the  parents  can  this  need  be  filled.  The 
appalling  condition  of  the  teeth  in  our  adult  population  was  fully 
realized  for  the  first  time  when  our  draft  army  was  examined.  In 
four  counties  the  Red  Cross  maintains  dental  clinics.  These  are 
Dutchess,  Fulton,  Nassau  and  Westchester.  The  clinic  in  Nassau 
County  is  mobile  and  reaches  the  entire  county.  It  has  now 
become  practically  self -supporting.  The  clinic  in  Dutchess  County 
is  maintained  in  co-operation  with  the  County  Health  Association. 
A  number  of  cities  and  villages  have  adopted  the  method  of  secur- 
ing volunteer  services  of  dentists  who  are  willing  to  give  some 
time  for  the  free  treatment  of  indigent  children,  and  clinics  main 
tained  in  this  way  are  accomplishing  a  good  deal  but  are  very 
seldom  sufficient  for  the  needs.  Out  of  the  58  cities  and  450  incor- 
porated villages  in  the  State,  50  have  provided  some  form  of  dental 
service.  That  a  beginning  is  being  made  and  also  the  labor 
entailed,  is  indicated  by  an  occasional  report  like  the  following 
from  one  of  our  county  chairmen: 

"You  will  be  interested  to  hear  that  last  Saturday  there  was  a  very 

successful  dental  clinic  held  by  three  of  the  remote  schools  in 

district.     This   gives  me  a    great   deal  of  satisfaction,  for  it   has  taken 
a  year  of  preparatory  work  to  get  the  thing  under  way." 

This  county  contains  nearly  200  schools,  so  the  difficulty  of 
getting  them  all  covered  by  the  activities  of  a  private  organization 
can  well  be  imagined. 

Rural  Problems.  When  the  present  situation  in  regard  to  medi- 
cal work  in  rural  sections  is  fully  appreciated,  the  difficulty  in 
securing  careful  medical  inspection  for  so  many  small  scattered 
schools  assumes  very  large  proportions.  There  are  250  townships 
in  this  state  which  have  no  physician.  The  shortage  in  rural  com- 
munities is  increasing  every  year,  and  the  younger  men  are  not 
taking  up  country  practice.  The  average  age  of  the  men  now  in 
rural  practice  is  considerably  over  50  years,  and  as  they  die  or  re- 
tire many  of  their  places  are  not  filled.  And  it  is  not  only  the  fact 
of  the  scarcity  of  physicians  which  is  important,  for  many  of  these 
men  are  "old  timers"  and  both  careless  and  ignorant,  judged  by 
our  modern  standards.  They  have  not  learned  to  use  the  more 
recently  invented  instruments  of  precision  which  make  accurate 
diagnosis  so  much  more  probable  and  they  have  not  adopted 
modern  standards  of  hygiene.  Many  of  them  use  a  single  spoon 
or  tongue  depressor  for  all  of  the  children,  and  some  of  the  com- 

50 


plaints  in  regard  to  vaccination  are  well  justified  because  of  the  ] 
physician's  ignorance  or  carelessness  in  regard  to  the  proper/ 
technique  and  the  need  of  cleanliness. 

This  is  not  intended  as  a  wholesale  indictment  of  rural  physi-j 
cians.  Many  are  very  able  men  and  they  endure  hardships  anal 
make  sacrifices  that  few  city  physicians  would  care  to  face.  They\ 
deserve  all  credit  for  the  splendid  work  they  do  but  the  fact  re-  N 
mains  that  the  school  children  are  not  getting  the  attention  that 
they  need.  Possibly  the  best  men  are  not,  as  a  rule  willing  to 
undertake  the  school  work.  It  has  not  been  presented  to  them 
as  a  fine  piece  of  community  service.  Whatever  the  reason  may 
be  the  results  are  definite  and  it  is  high  time  to  arouse  a  ques- 
tioning attitude  in  each  school  district  in  regard  to  the  sort  of 
service  it  is  getting. 

Some  of  the  comments  on  the  questionnaires  in  regard  to  medi- 
cal inspection  were  as  follows: 

"No  follow  up  work need  nurse,  medical  inspector  of  very 

little  value money  given  to  him  is  wasted." 

"No  children  receive  treatment  unless  the  parents  follow  up  the 
medical  examination  which  is  very  seldom  done  because  the  examina- 
tions are  a  farce." 

"No  child   received  medical  attention  who  needed   it." 
"No  treatment;  distance  too  great;  nurse  needed." 
"Medical  inspection  more  thorough,  as  it  is  sometimes  mere  form.*' 
(19  children  examined  in  15  minutes). 

"Head  inspection  for  lice,  and  the  remedy." 

"There  seems  to  be  an  outbreak  of  some  disease,  and  if  school  could 
be  visited  by  nurse  or  doctor  it  would  reduce  the  number  of  cases." 

"The    doctors   are   not   to   blame   for   the   conditions  that   appear   to 
exist.     The  first  years  they  spent  much  time,  but  the  parents  did  not 
do  their  part.     Unless  there  is  a  good  follow  up  system  the  doctors  can 
do  little  but  advise,  which  does  not  accomplish  much." 
From  one  school  where  the  Parent-Teacher  Association  is  tak- 
ing responsibility  for  the  follow  up  work: 

"I  find  the  doctors  are  only  too  willing  to  give  their  time  free  and 
also  take  a  great  interest  when  they  see  their  work  is  resulting  in  some 
definite  good." 

"One  girl  with  tubercular  hip  who  should  have  been  attending  this 
school  and  would  have  been  found  by  any  nurse  or  medical  inspector, 
was  left  without  attention  for  two  years.  A  follow  up  and  inspection 
system  is  certainly  necessary  there." 

"There  is  absolutely  no  follow  up  work  of  any  kind.  The  doctor 
examines  the  children  once  a  year  and  everything  else  is  left  to  the 

51 


teacher,  who  has  no  cooperation  from  the  community  or  parents.  In 
many  cases  she  does  not  even  know  the  requirements  of  the  state  law.' 

"The  doctor  asked  the  children  if  they  could  see  and  hear  well.  As 
would  be  expected,  all  said  'yes'." 

"Doctor  lifts  them  when  he  comes,  and  guesses  weight." 

"Medical  inspection  for  1920-1921  has  not  been  made,  although 
repeatedly  requested." 

"Not  any  children  received  treatment." 
One  district  superintendent  wrote: 

"The  fact  is  the  conditions  are  too  deplorable  to  report What 

few  medical  inspectors  are  employed  do  their  work  at  a  school  in  a 
few  minutes,  collect  their  fees  and  pass  on  and  that  ends  the  whole 
health  business  for  the  children  until  the  next  year,  when  the  same 
farce  is  repeated,  while  many  school  districts  do  not  even  employ  this 
farce  medical  inspection.  Any  attempt  to  have  a  nurse  or  a  physical 
training  teacher  is  fought  by  the  rural  population  most  bitterly,  as  are 
any  attempts  at  improving  the  physical  surroundings  of  the  children, 
such  as  drinking  fountains,  heating  and  ventilating  system,  decent  toilets, 
oiling  floors  to  prevent  dust,  slate  blackboards  and  the  like.  As  soon 
as  I  am  convinced  that  the  women  of  your  league  really  have  the  wel- 
fare of  the  children  of  the  rural  schools  at  heart  enough  to  set  out  to 
bring  about  the  employment  of  good  medical  examiners  with  follow 
up  work  with  school  nurses  and  the  other  needed  reforms,  you  may 
count  on  me  to  the  limit." 

Difficulty  in  getting  careful  medical  inspection  and  follow  up 
work  may  occasionally  have  its  source  in  the  attitude  of  a  school 
superintendent  such  as  the  following  one.  It  is  interesting  to 
contrast  his  attitude  with  that  of  the  man  quoted  above. 

"The  superintendent  and  principal  of  this  school  is  a  Christian 
Scientist  and  is  a  very  old  gentleman.  He  does  not  believe  in  being 
particular  about  sanitary  conditions,  that  is  cleanliness,  thinks  the 
'germ  craze'  as  he  calls  it,  is  all  nonsense,  thinks  all  this  physical 
instruction  and  gymnastics  is  unnecessary.  Never  heard  of  Disease 
Census  Card  or  Susceptibility  Chart,  although  issued  by  the  Educational 
Department.  Says  teachers  open  windows  too  often.  The  general  opin- 
ion of  this  school  is  that  health  conditions  are  very  lax.  The  building  is 
old.  The  standing  of  the  school  is  very  poor.  Children  in  this  district 
are  being  sent  by  their  parents  to  the  other  village  district  on  account 
of  being  better  educational  advantages  and  better  medical  inspection, 
thus  tending  to  overcrowd  the  better  school. 

"Dental  attention.  Some  provision  for  poor  children  to  get  thrir 
teeth  cared  for  at  the  important  time  of  their  life  for  proper  development 
of  teeth." 

"I  think  the  school  would  profit  by  a  school  nurse.  The  medical 
inspection  would  have  its  follow-up  work.  The  parents  could  be 
instructed  on  feeding  the  children.  The  teacher  can  do  this  but  not 

52 


so  satisfactorily.    Rural  children  are  fed  outrageously." 

"Action  to  care  for  one  pupil  15  years  old  who  has  terrific  fits, 
and  exclude  him  from  school." 

"School  nurse  to  encourage  better  living  conditions  at  home.  Most 
mothers  are  foreigners  in  this  district  and  need  instructions  in  home- 
making  and  sanitation." 

"Careful  follow-up  work  after  medical  inspection,  regular  visits  by 
school  nurse.  Some  follow-up  work  could  be  carried  out  if  financial 
aid  was  given." 

"Medical  inspection  in  school  too  hurried.  No  eye  and  ear  test 
given.' 

"I  think  a  report  of  the  health  examiner  should  be  sent  to  the 
parents.  Only  2  of  the  32  children  examined  were  found  perfect." 

"In  my  district  the  teeth  of  the  children  need  attention.  I  wish  it 
was  in  my  power  to  send  out  a  dental  ambulance,  manned  by  a  dentist 
and  one  or  two  dental  hygienists  to  clean  the  teeth  and  where  possible 
make  temporary  fillings.  The  second  question  of  importance  is  the 
removal  of  diseased  tonsils  and  adenoids."  (Signed  by  district  superin- 
tendent.) 

"Patients  ignore  the  defects.  Several  cases  of  diseased  tonsils  have 
been  reported  for  the  third  time  this  year.  These  children  are  behind 
in  their  school  studies  as  a  result." 

"The  school  is  12  miles  from  doctor  or  dentist." 
"More  attention  to  control  of  communicable  diseases.     School  closed 
8  weeks  on  account  of  scarlet  fever." 

Conclusion.  It  is  not  our  wish  to  give  the  impression  that 
nothing  is  being  done  in  the  state  or  that  conditions  are  entirely 
bad.  Much  splendid  work  is  being  done  in  some  communities, 
especially  in  the  larger  cities.  This  work  is  not  described  in  detail 
in  this  report  because  it  has  been  our  wish  to  indicate  what  still  is 
to  be  accomplished  rather  than  to  stress  what  has  been  done. 
When  we  consider  that  50  cities  and  villages  have  established  some 
form  of  dental  service  for  school  children,  and  400  dentists  have 
designated  children's  service  hours,  it  is  evident  that  a  good  start 
has  been  made.  As  this  work  is  extended  the  cities  will  be  cared 
for,  but  the  situation  is  quite  different  in  the  rural  sections  and  in 
most  villages.  There  are  250  full  time  school  nurses  in  the  state, 
most  of  them  in  cities  and  large  villages,  and  500  other  nurses 
doing  some  work  in  the  schools,  but  when  we  remember  that  nearly 
nine-tenths  of  our  schools  are  rural,  it  is  not  surprising  that- our 
questionnaires  show  only  15%  visited  reguarly.  The  Chief  Medi- 
cal Inspector  of  the  State  estimates  that  during  the  last  four  years 
36.6%  of  the  defects  discovered  in  city  children  were  treated  as 
compared  with  only  22.7%  of  those  in  rural  children.  It  must  be 

53 


borne  in  mind  that  these  percentages  are  of  defects  discovered,  not 
of  total  defects  existing  and  everyone  familiar  with  the  problems 
of  medical  inspection  realizes  that  a  great  many  more  physical 
defects  were  not  discovered. 

HEALTH  INSTRUCTION 

Practically  all  schools  give  some  simple  health  instructions, 
including  the  importance  of  sleeping  with  open  windows,  of  clean- 
liness and  proper  foods.  This  work  is  usually  left  to  the  initiative 
of  the  teachers,  and  the  extent  of  it  consequently  depends  upon 
their  own  interest  in  the  subject.  There  is  no  uniformity  in  the 
manner  of  presenting  these  subjects,  but  we  find  such  instructions 
frequently  given  in  connection  with  the  courses  in  physiology.  In 
schools  where  visits  are  made  regularly  by  nurses,  the  latter  often 
give  talks  on  hygiene.  Occasional  lectures  or  talks  of  this  kind 
are  of  great  value,  but  much  more  regular  instruction  is  essential 
if  the  children  are  to  actually  form  health  habits. 

The  frequent  visits  of  a  school  nurse  are  a  strong  incentive 
to  both  teacher  and  pupils  to  develop  interest  in  this  important 
field,  and  the  monthly  weighing  of  all  children  with  a  classroom 
weight  chart  serves  not  only  to  pick  out  the  undernourished 
children  who  need  special  attention,  but  to  emphasize  to  all 
children  the  importance  of  keeping  up  to  the  standard.  It  is  also 
a  valuable  means  of  checking  up  the  real  results  of  the  health 
instruction  and  determining  whether  or  not  the  children  are  form- 
ing good  health  habits.  In  only  16%  of  the  schools  were  the 
children  weighed  every  month.  The  Department  of  Health  has 
estimated  that  one  out  of  every  five  children  is  undernourished, 
and  practically  all  of  this  is  due  not  to  poverty  but  simply  to  the 
fact  that  the  children  do  not  eat  the  proper  foods  and  do  not  get 
sufficient  sleep.  It  is  easier  to  teach  the  children  the  importance 
of  these  things  than  it  is  to  reach  the  parents  and  overcome  their 
ignorance  or  indifference.  Lack  of  co-operation  from  the  parents 
is  the  most  frequent  difficulty  complained  of  by  the  teachers  in 
regard  to  this  phase  of  the  school  work. 

A  few  teachers  who  are  particularly  interested  in  health  prob- 
lems find  opportunities  to  include  health  instruction  for  very 
young  children  in  other  subjects  such  as  arithmetic  or  penmanship. 
There  is  a  field  here  that  could  be  widely  extended.  From  the 
point  of  view  of  the  penmanship  alone  it  is  immaterial  what  sub- 

54 


ject  matter  is  used,  and  health  maxims  could  be  substituted  with 
great  advantage  for  many  of  the  simple  sentences  now  in  common 
use. 

The  most  frequent  means  now  used  for  arousing  the  interest  of 
school  children  in  health  subjects  is  the  brief  talk  by  the  teacher 
with  a  morning  inspection.  A  health  club  or  league  of  some  sort 
is  the  next  step  and  one  in  fairly  common  use.  From  69%  of  the 
schools  such  organizations  were  reported.  Health  exhibits  and 
poster  contests  prepared  by  the  children  are  more  frequently  found 
in  the  cities  and  larger  villages.  Only  28%  of  the  schools  had 
exhibits  of  any  sort.  Sometimes  they  were  prepared  by  the 
children.  Sometimes  they  were  in  the  form  of  lectures  or  the 
"Health  Clown"  or  "Health  Fairy"  etc.,  brought  in  by  cooperation 
with  some  outside  organization. 

Although  practically  all  schools  reported  giving  some  health 
instruction  13%  had  neither  health  clubs,  exhibits,  scales,  nor 
any  method  of  checking  up  to  find  out  whether  the  children  were 
forming  health  habits,  and  we  classed  these  as  showing  very  little 
interest  in  health  problems. 

In  a  few  of  the  cities  where  open  air  classes  are  held,  cots  with 
blankets  are  provided,  and  the  importance  of  rest  for  under- 
nourished children  can  be  both  taught  and  put  into  practice. 

The  difficulties  in  regard  to  health  instruction  in  rural  districts 
can  only  be  appreciated  when  the  condition  of  the  buildings  is 
fully  understood.  It  is  of  very  little  value  to  try  to1  teach  the  impor- 
tance of  washing  the  hands  before  handling  food  when  the  school 
has  no  water  supply,  and  gets  along  during  the  winter  without  even 
carrying  any  in.  A  few  quotations  from  the  questionnaires  may 
be  of  interest. 

"Teacher  bought  the  scales  herself." 

"I  would  like  to  be  able  to  weigh  the  pupils  regularly,  which  could 
be  done  if  there  were  scales  in  the  school.  There  are  scales  in  the 
district,  but  they  are  a  long  way  from  the  school  house." 

"More  time  to  teach  health  subjects." 

"Parents  will  not  do  their  part." 

"Health    charts   would   help." 

"Get  parents  interested." 

"Nurse   gives  health  talk  2   or  3  times  a  year." 

"If  we  could  have  class  room  charts  with  stars." 

"Weighed   monthly  at  station   or  home  and   report  themselves." 

"Weighed  'when  convenient.' " 

"More  health  talks." 

"A  regular  talk  by  doctor  or  nurse  or  outsider  on  health  subjects." 

55 


The  most  frequent  space  on  the  questionnaire  left  blank  was 
the  one  under  health  instruction:  "Ask  the  teacher  what  her 
suggestions  are  for  improvement."  Very  often  there  was  simply 
the  word  "none,"  and  still  more  often  it  was  a  blank.  This  must 
surely  indicate  either  a  lack  of  imagination  on  the  part  of  the 
teachers  or  fear  of  making  a  complaint.  But  complaints  were 
so  readily  made  in  regard  to  the  condition  of  the  buildings  and 
grounds  that  it  more  probably  indicates  the  former.  The  teachers 
as  well  as  the  children  need  education  in  health  subjects.  Their 
interests  do  not  yet  go  out  spontaneously  and  creatively  in  that 
field.  More  background  is  needed. 

PHYSICAL  TRAINING 

Physical  training  is  required  by  law  in  all  schools  of  the  state. 
This  law  is  very  indifferently  complied  with  in  many  places,  and 
in  some  completely  disregarded.  In  the  cities  and  large  villages 
which  have  a  sufficient  number  of  physical  directors  some  very 
fine  work  is  being  done,  but  throughout  the  rural  schools  this  is 
left  to  the  regular  teachers,  who  receive  their  instructions  from 
one  of  the  physical  directors.  Under  these  conditions  we  find 
that  the  work  consists  simply  of  a  few  exercises  given  daily  during 
the  school  hours.  Frequently  only  two  minutes  a  day1  are  spent  in 
this  way;  occasionally  it  is  omitted  completely.  It  was  usually  re- 
ported that  either  the  windows  or  the  door  were  opened  during 
the  exercises;  some  were  qualified  by  "in  good  weather,"  some  by 
"except  in  winter,"  some  by  "occasionally,"  one  teacher  asked 
"what  for?"  In  one  county  22  schools  reported  having  no  instruc- 
tion in  physical  education. 

There  are  577  directors  of  physical  education  in  the  state. 
Rockland  and  Nassau  employ  the  greatest  number  in  proportion 
to  their  total  population.  Some  counties  have  only  one.  Putnam, 
Schuyler  and  Seneca  are  in  this  class,  and  the  physical  director 
in  Seneca  County  holds  a  temporary  license. 

For  communities  which  are  not  large  enough  to  employ  both 
a  nurse  and  a  physical  director,  a  solution  is  provided  by  the 
State  Department  of  Education  through  its  policy  of  giving  a 
temporary  license  to  the  school  nurse  after  she  has  received 
some  special  instruction  which  fits  her  to  act  also  as  physical 
director.  Very  much  more  efficient  work  can  be  accomplished  in 

56 


this  way  than  by  leaving  it  to  the  individual  teachers,  some  of 
whom  are  interested  in  it  and  some  of  whom  are  not.  Of  the 
577  physical  directors  98  hold  temporary  licenses. 

Lack  of  a  gymnasium  in  a  large  city  school  is  a  serious  handi- 
cap and  one  that  was  reported  very  frequently,  not  only  from  the 
annexes  but  from  the  main  school  buildings  also.  No  questions 
were  asked  in  regard  to  the  presence  or  absence  of  a  gymnasium, 
so  this  was  another  of  those  needs  which  like  the  maps  and  text 
books  in  rural  schools,  came  out  quite  spontaneously  and  im- 
pressed us  particularly  because  of  its  frequent  repetition  on  the 
questionnaires  coming  from  city  schools. 

The  attitude  of  some  teachers  in  rural  schools  towards  the 
physical  training  requirements  is  indicated  by  the  following: 

"Not  more  physical  instructors  who  know  nothing  of  country  children, 
walking  from  two  to  four  miles  every  day,  after  working  two  or  three 
hours.  People  are  needed  to  make  laws  for  school  who  know  what 
a  country  school  is." 

SPECIAL  CLASSES 

It  has  been  estimated  by  the  State  Department  of  Health  that 
5%  of  the  children  of  school  age  have  now  or  have  had  tubercu- 
losis. The  cost  of  maintaining  sanataria,  hospitals  and  dispensaries 
for  our  tuberculous  adults  is  great  and  the  economic  loss  to  society, 
because  of  the  inability  of  many  of  these  individuals  to  work  and 
support  themselves  and  their  families,  is  also  considerable.  It  is 
well  recognized  that  tuberculosis  attacks  primarily  children  and 
young  adults,  and  it  is  also  admittedly  curable  if  treated  early. 
Resistance  to  it  should  be  developed  in  childhood,  and  the  value 
of  open  air  treatment  for  all  anaemic,  susceptible  children  has 
been  definitely  established,  yet  it  is  extremely  rare  to  find  open 
air  classes  provided  in  any  but  the  large  cities.  Of  all  schools, 
city  and  rural,  4.6%  stated  that  open  air  classes  were  available. 
Outside  Buffalo  and  Rochester,  16  cities  and  one  village  have  open 
idr  schools  or  school  rooms,  with  1,000  children  enrolled.  Buffalo 
has  4  open  air  classes  with  120  children  enrolled,  and  the  superin- 
tendent reports  that  1,500  children  need  such  care.  Rochester  has 
two  open  air  classes,  one  of  them  located  in  lola  Sanitarium. 

In  a  recent  speech  the  chief  medical  inspector  of  the  state  said, 
"Of  the  thousands  of  school  children  who  are  today  suffering  with 

57 


tubercular  infection,  comparatively  few  are  being  recognized.' 
Meanwhile  tuberculosis  still  causes  about  one  out  of  every  ten 
deaths  in  this  state. 

The  number  of  children  who  need  to  be  placed  in  special 
classes  because  of  backwardness  is  also  very  great.  Children  with 
very  marked  mental  defects  are  frequently  found  in  the  regular 
schools,  where  they  remain  year  after  year  without  progressing, 
serving  as  a  constant  source  of  trouble  for  the  teachers  and 
exerting  a  very  bad  influence  over  the  other  children.  Not  infre- 
quently they  are  expelled,  and  nothing  more  is  done  for  them. 

There  is  another  large  group  of  children  who  are  simply  back- 
ward and  not  necessarily  classed  as  defective  but  who  need  a 
special  form  of  training  along  vocational  lines.  The  ordinary 
school  offers  very  little  to  these  children,  and  their  only  wish  is 
to  grow  old  enough  to  get  to  work.  The  teacher  labors  wearily 
with  these  children,  and  they  usually  receive  a  disproportionate 
amount  of  her  time.  They  are  restless  and  mischief-making,  and 
their  presence  definitely  handicaps  the  other  children  who  could 
progress  more  rapidly.  The  law  requires  that  every  school  having 
10  or  more  such  children  should  establish  a  special  class  for  them, 
but  this  practically  does  not  affect  rural  schools  at  all,  in  the  first 
place  because  accurate  grading  is  so  difficult,  second  because  there 
is  seldom  any  provision  for  mental  testing,  and  third  because  the 
attendance  in  the  individual  school  is  so  small.  In  order  to  pro- 
vide the  proper  educational  advantages  to  these  children  and  to 
do  justice  to  the  other  children,  it  would  be  necessary  to  provide 
special  classes  which  would  serve  for  a  larger  unit  than  the  single 
school  district.  This  need  was  expressed  as  follows  on  one  of  our 
questionnaires : 

"At  least  one  backward  class  should  be  arranged  for  three  or  four 
school  districts  together.     Better  results  could  be  obtained  in  a  consoli 
dated  school  system,  both  for  pupils  and  teachers." 
From  a  school  of  50  children  in  one  of  our  most  progressive 
counties  came  this  report: 

"This  school  is  composed  almost  entirely  of  Italian  children.  There 
is  one  girl  age  12  high  grade  idiot,  and  one  boy  8  and  one  girl  8  nearly 
as  bad."  (Whatever  grade  of  defect  these  children  would  prove  to  have 
with  accurate  mental  testing,  it  is  evident  that  they  are  out  of  place  in 
this  school). 

"Lack    of    special    class   and    attention    to    subnormal   children." 
"One  defective  boy  needs  attention." 

58 


"Special  attention  to  a  small  group  of  backward  children.' 
"Two  real  defectives   in   school."      (Tested  by  physician  from   State 
Department  of  Health). 

There  are  at  present  175  special  classes  for  backward  children 
in  the  state,  but  these  are  distributed  chiefly  among  the  larger 
cities,  21  being  in  Buffalo.  Other  types  of  special  class  work  are 
occasionally  found  in  the  larger  cities.  Rochester  provides  special 
classes  for  the  physically  crippled,  those  with  defective  vision, 
ihose  with  speech  defects,  the  non-English  speaking,  the  truant 
and  incorrigible,  those  confined  to  hospital  or  institution,  and 
the  specially  gifted.  The  latter  is  a  very  unusual  finding  and  one 
which  promises  much  and  should  be  developed  in  every  city. 
Rochester  has  also  a  Child  Study  Department  with  a  staff  of 
psychologists. 

Buffalo  provides  special  classes  for  sight  conservation,  speech 
defect,  crippled  children,  wayward  boys  and  truants,  and  lip  read- 
ing. It  needs  many  more  classes  for  defective  children,  but  its 
request  for  nine  additional  ones  was  not  allowed  last  year  by 
the  council.  It  needs  also  a  special  department  for  testing  the 
mentality  of  such  children.  It  is  doing  nothing  yet  for  the 
specially  gifted  children. 

HOT  LUNCHES 

One  out  of  every  five  of  our  school  children  is  undernourished. 
This  is  a  serious  situation  which  can  no  longer  be  left  to  each 
individual  family  for  solution.  It  is  not  poverty  but  ignorance 
and  carelessness  that  serve  as  the  causative  factors.  In  many 
well-to-do  families  the  children  hurry  off  to  school  in  the  morning 
in  the  fear  of  being  late  without  finishing  their  breakfasts,  and 
for  lunch  they  have  only  what  they  carry  with  them.  It  is  not 
only  among  the  poor  and  the  alien  population  of  our  large  cities 
that  improper  food  is  given  to  children.  There  is  a  wide-spread 
ignorance  in  regard  to  the  needs  of  the  growing  child.  Very  few 
women  know  what  constitutes  a  well  balanced  diet,  and  the 
children  are  the  sufferers.  The  noonday  meal  at  school  serves  as 
a  valuable  means  of  teaching  food  values,  and  helps  to  bring  such 
health  instruction  down  to  a  level  of  practical  application. 

A  hot,  properly  cooked  meal  at  noon  is  almost  immediately 
reflected  in  the  work  done  by  the  children.  In  a  recent  study 

59 


made  of  the  results  of  feeding  undernourished  children,  86%  were 
found  to  show  "marked  improvement"  in  their  studies  and  con- 
duct. 

In  this  state  it  is  very  much  more  common  to  find  lunches 
provided  in  the  high  schools  than  in  the  elementary  schools. 
These  are  usually  sold  at  cost.  28  cities  and  16  villages  provide 


(Courtesy  of   the   Child  Health   Organisation) 
5.     The  school  lunch.     A  simple  form  of  health 


insurance. 


milk  in  some  of  their  schools  either  for  all  or  for  undernourished 
children  and  the  money  for  this  is  often  raised  through  the  activity 
of  some  interested  private  organization. 

Out  of  all  the  schools  investigated  68%  made  no  provision  for 
lunches;  2%  served  something  to  undernourished  children  (usu- 
ally milk,  sometimes  cocoa,  occasionally  milk  and  crackers)  ;  7% 
provided  for  a  hot  dish  or  drink  during  the  winter  months,  and 
14%  reported  serving  hot  lunches.  Sometimes  in  rural  schools 
this  merely  means  that  food  brought  by  the  children  is  warmed 
on  the  stove.  In  some  cases  the  teachers  supply  the  materials  and 
pay  for  them,  and  occasionally  the  parents  contribute  raw  mater- 
ials, either  as  individuals  or  as  a  Parent-Teacher  Association  or 
some  other  local  group.  In  city  schools  the  lunches  are  usuallv 
(served  at  cost,  and  it  is  optional  with  the  children  or  their 
parents  whether  or  not  to  take  advantage  of  them. 

A  great  many  teachers  in  rural  schools  said  that  they  would 
be  glad  to  serve  a  school  lunch  and  have  the  children  help  to 

60 


prepare  it,  but  they  had  no  utensils  or  stove  that  could  be  used 
for  such  a  purpose. 

In  a  considerable  number  of  the  schools  that  we  have  credited 
with  serving  hot  lunches,  only  the  merest  beginning  has  been  made 
and  no  regular  system  has  been  developed.  Occasional  qualifying 
remarks  after  the  question  has  been  answered  in  the  affirmative 
indicate  the  nature  of  many  of  these  lunches. 

"Children    roast    potatoes,    apples,    or    heat    other    things    they    may 
bring.     Children  furnish  their  own  if  they  have  any." 

"Pupils  sometimes  bring  soups,  etc.,  and  heat  on  stove." 

"The  children  often  bring  cocoa  and  milk  with  their  lunches." 

"Hot  cocoa  at  noon  in  winter;  children  and  teacher  furnish  materials." 

"Potatoes  baked  on  stove  if  wished  for." 

"A   cooking   utensil  in   which    cocoa   may  be   made  in   winter." 
An  indifferent  attitude  towards  this  question  on  the  part  of  the 
teacher  usually  is  not  reflected  on  the  questionnaire,  but  it  occa- 
sionally comes  out  in  an  answer  like  this  to  the  following  question; 
Are  lunches  available  for  all  children? 

"No,  they  can  bring  them  if  they  choose." 

USE  AND  SUPERVISION  OF  PLAY  TIME 

The  change  in  attitude  towards  play  is  one  of  the  outstanding 
features  of  modern  times.  Formerly  it  was  almost  considered  a 
waste  of  time  to  play,  or  at  least  such  activity  was  regarded  with 
indifference.  Now  we  are  realizing  that  it  has  an  extremely  impor- 
tant part  to  play  in  the  development  of  the  personality,  as  well  as 
the  more  obvious  function  of  contributing  toward  physical  "fit- 
ness". Capacity  for  "team  work",  co-operation,  standards  of  fair 
play,  and  the  ability  to  win  or  lose  with  the  poise  that  is  regarded 
by  all  as  belonging  to  a  "good  sport",  are  qualities  which  are 
invaluable  throughout  life  and  are  developed  most  easily  in  child- 
hood through  organized  and  supervised  play. 

The  importance  of  supervision  is  often  overlooked.  People 
are  inclined  to  feel  that  given  a  fair  amount  of  space  children 
can  take  care  of  themselves,  but  it  has  often  been  demonstrated 
that  the  bullies,  of  whom  there  are  a  few  in  practically  any  group 
of  children,  will  soon  dominate  the  situation,  and  the  more  timid 
children  will  not  get  a  chance  to  use  the  swings,  etc.  Left  alone, 
the  trend  of  the  over  aggressive,  selfish  child  tends  to  become 
firmly  established  and  the  timid  child  becomes  still  more  timid 

61 


and  perhaps  resentful.    With  supervision  and  justice  to  all  assured 
he  has  a  chance  to  develop  skill  and  become  self-confident. 

The  school  is  a  natural  unit  within  which  organized  play  can 
be  developed  in  a  most  satisfactory  manner.  Class  and  school  teams 
are  of  immense  value  in  contributing  towards  that  intangible  school 
spirit  or  loyalty  which  means  so  much,  and  which  carries  over 
into  the  more  serious  side  of  school  life.  School  entertainments 
serve  the  same  purpose  and  are  particularly  helpful  in  developing 
initiative  and  latent  talents  in  children.  Serving  on  small  school 
committees  is  a  good  preparation  for  many  of  the  activities  of 
adult  life  and  tends  to  bring  out  executive  ability  and  willingness 
to  assume  responsibility. 

All  of  these  more  social  aspects  of  school  life  center  about  the 
playground,  gymnasium  and  auditorium.  Every  school  should  have 
a  playground  and  at  least  every  high  school  should  have  a 
gymnasium  and  auditorium.  Only  12%  of  the  schools  investigated 
in  this  survey  were  reported  to  have  well  equipped  playgrounds. 
42%  need  better  playgrounds  or  equipment. 

The  remaining  46%  either  failed  to  answer  the  question  or 
the  attendance  was  so  small  that  we  felt  that  a  better  solution 
of  the  problem  could  often  be  found  through  consolidation  rather 
than  increasing  the  equipment  of  so  many  small  units.  The 
children  need  the  advantages  fully  as  much  as  those  in  the  larger 
schools,  but  at  the  present  time  it  is  obviously  impossible  to  expect 
small  rural  schools  to  provide  them.  They  haven't  begun  to 
meet  the  still  more  essential  needs  of  sanitation  and  educational 
equipment. 

Only  54%  of  the  schools  reported  having  entertainments  of 
any  sort  encouraged  and  supervised,  and  with  many  of  these  there 
was  simply  a  Christmas  party.  We  placed  them  in  this  clasa  if 
they  reported  any  school  entertainment  at  all  during  the  year. 
24%  stated  that  no  entertainments  were  provided  for  and  22% 
failed  to  answer  the  question.  It  is  fair  to  assume  that  failure  to 
answer  this  question  usually  means  that  there  were  no  enter- 
tainments. 

In  general  the  playground  needs  were  not  expressed  as  vividly 
on  the  questionnaires.     As  would  be  expected  the  other  points 
were  emphasized  more  frequently,  but  a  few  are  worth  quoting. 
"A  better  playground  and  not  a  mud  hole." 
"Children  have  to  play  in  the  street." 

62 


"312  children.  Playground  used  continually  during  fair  weather,  n,ot 
equipped.  Gymnasium  needed  also." 

"Playground  apparatus  to  keep  the  boys'  minds  off  fighting.  540 
children." 

"High  school.  Needs  gymnasium,  auditorium  and  playground  appa- 
ratus." 

"Surfacing  playground  so  that  it  can  be  used  without  ruining  one'a 
shoes." 

"Dead  trees  cleaned  from  the  school  ground  and  grounds  graded 
and  leveled." 

"A  baseball.  The  boys  chipped  in  together  and  bought  one  but 
it  was  so  poor  it  did  not  last  a  day." 

900  pupils.    "The  playgrounds  are  in  a  very  bad  condition." 

"Playground   needs  draining." 

"A  playground.  The  present  one  is  small  and  children  have  to 
play  in  the  road." 

SUMMARY 

There  are  11,824  schools  in  New  York  State.  1,342  are  in  cities, 
246  in  villages  and  the  remaining  10,236  are  in  the  rural  super- 
visory districts.  Thus  nearly  nine-tenths  of  our  schools  are  rural. 
8,600  of  these  are  one-room  buildings,  and  in  3,018  there  is  an 
attendance  of  less  than  10  pupils.  The  rural  school  district  is 
an  area  two  miles  square,  and  the  result  is  this  unnecessary 
duplication  of  cheap  buildings  containing  few  pupils  and  failing 
largely  to  attract  efficient  teachers.  It  has  been  estimated  that 
54%  of  the  schools  are  50  years  old  or  more,  and  that  13%  have 
been  in  existence  for  75  years.  Some  date  back  even  to  1812. 

Health  problems  in  these  schools  for  the  purpose  of  this  study 
were  grouped  into  seven  general  subjects,  medical  inspection, 
health  instruction,  physical  training,  condition  of  buildings,  spe- 
cial classes,  hot  lunches  and  the  use  and  supervision  of  playtime. 
4,244  schools  (36%  of  the  total  number)  were  covered  by  the 
investigation  and  questionnaires  were  received  for  some  schools 
in  all  but  four  counties.  These  were  grouped  as  follows :  508 
city  schools  (38%),  113  village  schools  (46%),  and  3,623  rural 
schools.  (The  latter  figure  represents  35%  of  the  total  rural 
school  buildings  in  existence,  but  it  is  estimated  that  about  8% 
of  them  are  not  in  use  but  contracting  with  neighboring  districts 
for  the  education  of  their  children,  so  the  percentage  of  actually 
maintained  schools  which  was  covered  is  somewhat  higher.) 
Medical  Inspection.  The  medical  inspection  law  provides  for 

63 


an  annual  examination  of  every  child  who  does  not  bring  a  health 
certificate  from  some  other  licensed  physician.  In  all  but  1.9%  of 
the  schools  this  form  was  complied  with,  but  in  39%  it  consisted 
only  of  a  very  cursory  inspection.  In  many  cases  no  eye  or  ear 
tests  were  made  and  the  heart  and  lungs  were  not  examined  with  a 
stethescope.  A  careful  examination  was  made  in  38 °/o  of  the 
schools  investigated.  21%  could  not  be  classified  because  of  insuffi- 
cient data.  There  is  a  good  deal  of  dissatisfaction  with  the 
system  of  medical  inspection  because  of  the  absence  in  so  many 
cases  of  any  provision  for  follow-up  work.  This  is  usually  depend- 
ent upon  the  services  of  a  nurse,  and  69%  of  the  schools  are 
never  visited  by  a  nurse.  Only  15%  are  visited  regularly  as  often 
as  once  a  month,  and  the  great  majority  of  these  are  in  cities  or 
large  villages.  On  the  whole,  medical  inspection  is  very  much 
better  in  cities  than  in  rural  sections,  and  more  follow-up  work  is 
possible.  Medical,  surgical  and  dental  clinics  are  usually  avail- 
able in  cities  but  in  many  cases  they  are  insufficient  for  the  needs; 
especially  is  this  true  of  dental  clinics.  In  general  a  considerably 
greater  proportion  of  defects  are  corrected  in  the  cities  than  in  the 
rural  districts. 

Health  Instruction.  Simple  forms  of  health  instruction  are  given 
in  practically  all  schools,  including  talks  on  personal  hygiene, 
cleanliness,  proper  foods,  etc.  69%  of  the  schools  had  formed 
health  leagues  or  clubs  of  some  sort  to  stimulate  interest  on  the 
part  of  the  children,  and  to  make  more  probable  the  formation  of 
health  habits.  28%  had  made  use  of  exhibits  either  prepared  by 
the  children  or  brought  in  from  outside.  16%  weigh  their  chil- 
dren every  month  and  keep  a  class  room  record.  13%  showed 
very  little  interest  in  health  problems  and  reported  no  means  of 
checking  up  to  find  out  whether  the  children  were  forming  health 
habits. 

Physical  Training.  The  large  city  schools  have  regular  instruc- 
tion in  physical  training  given  by  the  physical  directors.  This  is 
also  done  in  some  of  the  villages.  Occasionally  the  school  nurse 
is  also  qualified  to  act  as  physical  director.  In  the  rural  schools, 
however,  this  is  left  to  the  regular  teacher,  who  receives  her  instruc- 
tions from  one  of  the  physical  directors.  The  work  under  such 
circumstances  most  often  consists  of  merely  a  few  exercises  during 
the  school  hours.  The  windows  are  usually  opened  during  these 
few  minute  periods. 

64 


Condition  of  Buildings.  According  to  the  regulations  adopted 
by  the  State  Department  of  Education,  a  sanitary  survey  of  the 
school  and  its  equipment  should  be  made  each  year.  61%  of  the 
local  school  authorities  had  reported  that  they  had  complied  with 
this.  The  rural  school  is  usually  cleaned  only  once  a  year,  some- 
times not  as  often  as  that,  and  for  the  rest  of  the  time  depends 
upon  such  sweeping  or  mopping  as  the  teacher  or  pupils  caret  to 
give  it.  It  contains  quantities  of  dust  and  powdered  chalk,  and  oil 
for  the  floors  is  a  very  frequent  need.  The  dust  is  stirred  up  by 
dry  sweeping,  and  much  of  it  remains  in  the  room.  At  least  11%  of 
the  buildings  now  in  use  are  poorly  lighted  and  inadequately  venti- 
lated. In  many  others  the  windows  are  so  arranged  that  there  is 
often  a  strong  glare  directly  in  front  of  the  children's  eyes,  pro- 
ducing eye  strain  at  all  times,  and  making  it  particularly  difficult 
to  see  what  is  written  on  the  blackboard.  Overcrowding  is  not  a 
feature  of  these  schools  in  contrast  to  the  city  schools.  Quite  the 
opposite  state  of  affairs  eixsts,  the  schools  far  too  often  being  run 
for  a  very  insufficient  number  of  pupils  at  a  disproportionate 
expense. 

It  is  so  difficult  to  heat  some  of  these  schools  that  the  windows 
are  only  infrequently  opened  during  the  winter.  They  occasion- 
ally become  frozen  down  for  long  periods  of  time.  Sometimes 
they  are  nailed  down.  19%  reported  that  their  temperature  could 
not  be  well  regulated  and  36%  had  no  thermometer.  Old  double 
seats  are  in  use  and  are  impossible  to  adjust  to  the  changes  of  a 
growing  child.  The  disadvantages  of  having  two  children  seated 
at  a  desk  together  are  obvious  but  such  a  condition  was  reported 
from  13%  of  the  schools.  In  28%  the  desks  could  not  be  adjusted 
to  fit  the  children.  This  probably  does  not  include  the  total 
percentage  of  schools  with  the  old  style  of  desk  but/  in  the  others 
there  were  so  few  children  that  each  could  be  fairly  well  fitted. 

23%  of  rural  schools  have  no  water  supply,  and  water  must  be 
carried  in  a  pail  from  a  neighbor's  well.  Where  the  school  has 
its  own  well  the  pail  with  a  dipper  for  drinking  purposes  is  a 
very  common  finding.  In  many  cases  where  individual  drinking 
cups  are  reported  as  being  used,  the  children  simply  keep  their 
cups  in  their  desks  but  dip  them  into  the  common  pail.  26% 
have  no  lavatories.  In  the  others  there  is  usually  a  single  basin, 
and  it  is  the  rare  exception  to  find  individual  towels,  paper  or 
otherwise,  provided.  55%  of  rural  schools  still  have  outdoor 

65 


privies,  and  13%  of  all  toilets  were  reported  to  be  in  very  poor 
condition.  Some  of  the  latter  were  chemical  or  flush  closets  in 
villages  and  cities  but  the  majority  were  outdoor  privies. 

In  the  cities  overcrowding  is  a  very  serious  problem.  With  few 
exceptions  our  larger  cities  have  outgrown  their  school  equipment 
and  are  finding  it  almost  impossible  to  get  the  necessary  funds 
for  increasing  it.  Conditions  result,  in  many  cases,  which  are  a 
definite  menace  to  the  health  of  the  pupils.  Annexes  are  used 
which  are  quite  unsuitable,  and  classes  are  held  in  basements  and 
rooms  with  artificial  light  and  insufficient  ventilation.  Many 
school  buildings  which  were  well  constructed  have  been  improperly 
cared  for,  and  the  artificial  systems  of  ventilation  seem  to  be 
particularly  vulnerable.  The  toilets  in  modern  well  built  schools 
are  occasionally  improperly  cared  for  and  permitted  to  get  out 
of  order  but  they  are  usually  sufficient  in  number  and  in  fair 
condition.  On  the  whole,  much  more  sanitary  conditions  arc 
found  in  the  city  and  village  schools  than  in  the  rural  ones.  Lav- 
atory facilities  are  usually  sufficient  for  the  needs,  and  in  a  fairly 
large  number  of  schools  paper  towels  are  provided.  The  purity 
of  the  drinking  water  is  almost  always  assured  by  municipal 
testing. 

Of  the  4,244  schools  investigated,  8.8%  were  found  to  be  in 
excellent  sanitary  condition,  53%  were  fair  in  this  respect  and 
36%  were  distinctly  unsanitary  and  constituted  a  real  menace  to 
the  health  and  proper  development  of  the  children. 

Special  Classes.  These  are  very  seldom  found  in  rural  schools. 
There  are  not  often  a  sufficient  number  of  children  in  any  one 
school  needing  such  attention  to  make  the  need  seem  urgent,  and 
yet  when  the  total  number  of  backward  children  is  considered  the 
need  is  great.  Only  by  establishing  a  larger  unit  of  administra- 
tion can  special  class  work  be  effectually  developed  in  rural 
communities.  12%  of  the  schools  investigated  reported  having 
special  classes  for  backward  children,  and  4.6%  had  open  air 
classes,  not  necessarily  in  their  own  building,  but  available  for 
use  by  their  children. 

Hot  Lunches.  Lunches  can  usually  be  obtained  in  High  Schools 
at  about  cost.  The  tendency  to  serve  hot  lunches  or  a  hot  dish  at 
noon,  at  least  in  the  winter  months,  is  steadily  increasing.  14%  of 
all  the  schools  investigated  served  a  hot  lunch  of  some  sort  either 

66 


free  or  at  cost.  7%  (usually  rural  schools)  prepared  a  hot  dish  or 
drink  during  the  \vinter,  and  68%  made  no  provision  for  lunches, 
the  children  sometimes  going  home  but  very  often  depending 
upon  cold  lunches  carried  with  them. 

Use  and  Supervision  of  Playtime.  The  need  for  playground 
space  and  equipment  in  our  cities  cannot  be  over-emphasized  and 
the  longer  these  municipalities  wait  before  securing  land  for  play- 
grounds, the  greater  the  cost  will  be.  The  importance  of  properly 
directed  and  supervised  play  for  small  children,  and  games  requir- 
ing skill,  self  control  and  team  work  for  older  ones,  is  fully  estab- 
lished, but  our  cities  are  very  slow  in  providing  playground  and 
gymnasium  space  or  equipment.  In  the  villages  and  the  larger 
rural  schools  adequate  space  is  more  often  available,  but  good 
equipment  is  rarely  found.  In  the  strictly  rural  school  it  is  prac- 
tically non-existent.  Only  12%  of  all  the  schools  had  large  well 
equipped  playgrounds.  42%  more  were  large  enough  to  warrant 
such  an  expenditure  and  were  in  real  need  of  either  equipment  or 
space  or  both.  Many  of  the  city  schools  are  in  need  of  an  audi- 
torium or  suitable  place  for  entertainments.  54%  of  all  the  schools 
reported  that  they  encouraged  and  gave  supervision  to  entertain- 
ments. 24%  made  no  provision  of  this  sort  of  thing. 

RESPONSIBILITY  OF  COMMUNITY 

Under  the  present  system  the  responsibility  for  conditions  in 
any  rural  school  district  comes  squarely  back  to  the  adult  resi- 
dents of  that  district.  It  is  they  who  elect  the  trustees  and 
determine  the  policy  in  regard  to  expenditures.  The  power  of 
the  State  Department  of  Education  is  very  limited.  It  can  and 
does  establish  regulations  which  must  be  complied  with  if  nev/ 
buildings  are  to  be  constructed,  but  it  stands  almost  helpless 
before  the  large  number  of  antiquated,  unsanitary  buildings.  It 
occasionally  condemns  a  building,  but  we  find  such  buildings  still 
in  use.  It  has  not  sufficient  popular  support  to  enable  it  to  enforce 
its  regulations,  as  was  proved  in  its  failure  to  get  outdoor  toilets 
done  away  with.  It  is  necessary  to  go  through  the  long  slow  pro- 
cess of  interesting  each  school  district  individually  in  the  question 
of  sanitary  toilets,  and  in  its  thousand  and  one  other  needs. 

In  city  schools  the  responsibility  also  comes  back  eventually 
to  the  general  public,  but  it  is  so  far  removed  from  the  individual 

67 


citizen,  and  sometimes  so  tightly   wound  up  in  politics  that  the 
average  citizen  has  very  little  chance  to  make  his  wants  felt. 

In  the  country  the  average  citizen  is  either  ignorant  of  school 
conditions  or  indifferent.  In  the  city  he  is  probably  indifferent 
also,  although  he  excuses  it  on  the  ground  of  impotence.  We  can 
more  or  less  endure  having  our  streets  and  public  buildings  made 
the  playground  of  political  parties,  but  our  schools  surely  should 
be  run  on  non-partisan  principles.  That  the  city  schools  are  so 
far  ahead  of  the  rural  ones  in  regard  to  the  educational  advan- 
tages offered  is  due  simply  to  the  fact  that  it  is  possible  to  get 
better  executives  to  undertake  a  large  piece  of  work  than  a  small 
one,  and  that  education  like  anything  else  can  be  provided  more 
economically  in  large  quantities  than  in  small  lots.  It  has  been 
figured  out  by  the  Department  of  Education  that  it  costs  twice 
as  much  to  educate  a  child  in  a  school  of  less  than  10  pupils 
as  it  does  in  a  city  school. 

It  is  only  through  bringing  home  vividly  the  needs  of  the 
schools  and  the  responsibility  of  all  of  us  that  we  can  get  direct, 
effective  action,  and  popular  support  of  a  progressive  policy. 

The  indifference  of  the  residents,  parents  and  others,  in  school 
problems  was  emphasized  very  frequently  on  our  school  question- 
naire. Some  are  quoted: 

"Better  fathers  and  mothers,  who  will  see  that  we  have  better 
buildings,  better  equipment,  better  teachers." 

"The  school  (225  pupils)  needs  a  sanitary  toilet  system;  several 
lavatories;  a  janitor  who  will  do  his  work  in  a  satisfactory  manner; 
a  Board  of  Education  that  will  work  for  improvement  of  schools  rather 
than  to  keep  down  taxes." 

"More  social  life  in  the  school  and  better  facilities  which  could 
be  secured  by  consolidation  with  nearby  districts." 

"Practically  all  rural  schools  need  more  than  the  taxpayers  can 
give  them." 

"Liberal  minded  trustees." 
"Trustees  asleep." 

"Some  way  of  interesting  the  parents  in  the  school  life  of  the 
children." 

"Interest  of  parents  in  modern  education." 
"Community  spirit." 

"If  parents  could  be  made  to  see  the  needs  of  the  children  they 
could  improve  the  school." 

"An  atmosphere  such  that  would  make  the  community  know  that 
the  public  school  existed  for  the  pupils  rather  than  the  pupils  for  the 
public  school." 

68 


"Get  people  alive  to  the  work  of  the  school." 

"Indifference  of  parents.  Lack  of  cooperation.  Not  enough  inter- 
est shown  by  people  in  the  district  in  visiting  the  school." 

"Financial  support  by  the  district,  followed  by  a  little  personal 
interest  in  the  progress  of  the  children,  mixed  with  some  broadminded- 
ness  and  seasoned  with  common  sense." 

"Compulsory  education  of  the  parent  in  regard  to  need  of  text 
books,  charts,  ventilation,  need  of  play,  medical  attention  and  more." 

"Parents   are  not  interested   in   welfare   of  school." 

"Interest  in  the  school  seems  to  be  lacking  by  the  people  in  the 
district." 

"This  little  school  is  one  of  the  most  attractive  in  the  district  due 
to  the  interest  of  a  certain  family  in  the  neighborhood." 

13  pupils.  "We  have  nothing  but  a  poor  building  which  is  poorly 
kept,  and  a  few  books.  The  main  trouble  is  that  the  school  is  a 
secondary  thing  and  they  want  to  get  along  with  the  least  possible 
expense." 

"Parents  should  realize  that  they  are  not  living  in  the  log  cabin  age." 

RECOMMENDATIONS. 

As  a  result  of  the  school  health  survey  in  New  York  State, 
it  would  seem  that  certain  definite  lines  of  action  should  he 
followed.  The  recommendations  given  are  those  which,  basically 
or  materially,  affect  the  health  of  the  children: 

1.  An  adequate  building  program  that  shall  care  for  the 
needs  of  the  present  and  provide  for  the  needs  of  the  future. 
The  need  of  more  school  buildings  is  particularly  evident  in  the 
cities.  The  lack  of  any  attention  to  this  matter  during  the 
years  of  the  war  has  resulted  in  a  situation  which  needs  imme- 
diate attention.  City  schools  are  overcrowded  and  in  many  in- 
stances have  been  allowed  to  degenerate  in  plant  and  equipment. 

Building  plans  for  rural  schools  should  take  into  consideration 
the  question  of  consolidation.  The  present  type  of  rural  school 
house  is,  in  many  instances  a  disgrace  to  the  community  and 
a  menace  to  the  health  of  the  children.  Building  programs  for 
the  future  must  take  into  account  the  health  as  well  as  the  scho- 
lastic needs.  The  country  school  house  need  not  be  costly  or 
elaborate,  but  it  must  provide  for  proper  drainage,  sanitary  toilet 
facilities,  an  adequate  supply  of  pure  water,  proper  ventilation, 
lighting  and  heating  and  the  equipment  and  maintenance  of  the 
classrooms  in  accordance  with  the  well-known  requirements  of 
school  hygiene.  While  the  rural  school  is  not  overcrowded,  its 

69 


sanitary  deficiencies  are  so  great  that  the  need  for  a  proper  build- 
ing program  is  as  great  in  the  rural  communities  as  it  is  in 
the  cities. 

2.  A    separate    budget    should   be   maintained    in    each    com- 
munity   for    all    school    needs,    including    the    matter    of    health 
supervision.     This  was  found  to  be  the  usual  method  of  financial 
administration  in  cities  of  the  third  class.     Here  the  boards  of 
education  have  complete  control  of  the  tax  budget  and  levy  the 
school  taxes.     It  would  be  wise  to  have  such  a  system  extended 
to  cities  of  the  first  and  second  class,  making  the  school  boards 
absolutely  responsible.     This  would  provide  also  for  a  more  con- 
tinuous   and    effective    school    administration    and    eliminate    the 
present  dependency  of  school  boards  upon  the  variable  and  often- 
changing  political  conditions  in  the  community. 

3.  The   county  unit   should  be  established   as  the  basis   for 
school  administration  and  taxation.     This  will  not  be  easy.     The 
first  step  must  be  to  make  the  situation  clear  to  the  people  of  the 
state  so  that  they  will  be  willing  to  try  out  the  new  system.    Some- 
thing more  than  a  permissive  legislative  act  is  required.     Local 
opinion  must  undoubtedly  be  the  force  behind  all  efforts  at  con- 
solidation of  the  schools.     The  experience  of  other  states  in  this 
matter  has  shown  that  the  enlargement  of  the  school  district  with 
the  establishment  of  fewer,  more  centrally  localized  schools  which 
are  well  built  and  well  equipped,  has  resulted  in  the  provision  of 
more  nearly  adequate  educational  facilities,  proper  sanitary  and 
hygienic  surroundings  and  that  it  is,  above  all,  economical.     The 
transportation  of  children  in  proper  conveyances  can  be  carried  on 
without  hardship  or  injury.     It  has  been  proved  that  instead  of 
decreasing  the  attendance  at  school,  the  county  unit,  with  these 
larger  schools,  has  actually  increased  the  attendance.    There  is  less 
truancy.     The  classes  can  be  graded  and  the  children  have  the 
added  interest  of  working  and  playing  with  groups  of  children 
of  the  same  age  and  interests.    The  cost  has  been  shown  to  be  not 
as  great  as  where  a  number  of  small  schools  are  maintained  and 
the  burden  of  taxation  would  not  fall  as  heavily  upon  many  small, 
poor  communities  which  are  now  required   to  maintain  schools 
for  only   a   few   pupils.      It  should   also   be   recognized  that   the 
position  of  county  superintendent  offers  a  larger  and  consequently 
more  attractive  field  to  an  administrator  with  ability  than  does 

70 


6.     Conveying  children  to  centralized  rural  schools  by  the  modern  method. 

the  present  supervisory  district.  A  proper  program  for  consoli- 
dating the  rural  schools  would  seem  to  be  an  urgent  need  of  the 
present. 

4.  Every  school  child  in  the  state  should  be  under  careful 
health  supervision.  This  means  that  sufficient  physicians  and 
nurses  should  be  employed  to  visit  the  schools  at  regular  intervals 
and  to  supply  the  necessary  health  instruction  and  care.  In  rural 
communities  there  should  be  a  physician  for  every  3,000  children 
and  a  nurse  for  from  1,000  to  1,500  children,  depending  upon  the 
distances  to  be  traveled.  In  cities,  there  should  be  a  physician 
for  every  5,000  children  and  a  nurse  for  every  2,500.  Anything 
less  than  this  is  inadequate  and  proper  health  care  will  not  be 
assured.  Provision  should  be  made  for  proper  medical,  surgical 
and  dental  clinics  in  every  community  so  that  the  health  needs 
of  the  child  may  be  met.  This  system  of  health  inspection  should 
be  under  constant  supervision  by  the  proper  officials  of  the  state. 
The  methods  to  be  followed  should  be  carefully  outlined  by  the 

71 


chief  medical  inspector  of  the  state  and  he  or  the  department 
which  he  represents  should  have  the  authority  to  see  that  the 
methods  are  followed  in  all  communities. 

5.  Instruction  in  health  matters  and  health  habits  should  be 
carried  on  in  a  more  vital  and  interesting  manner.     The  mere 
teaching  of  hygiene  is  not  enough  to  stimulate  interest  in  health 
topics.     At  the  present  time  such  talks  on  health  should  be  given 
by  the  school  doctor  or  the  school  nurse,  but  provision  should  be 
made  in  our  normal  schools  for  teachers  so  that  future  graduates 
may  have  had  the  opportunity  of  receiving  a  complete  course  of 
instruction  in  teaching  health  habits  and  proper  methods  of  living. 

6.  A  sanitary  survey  of  every  school  and  its  equipment  should 
be  made  each  year.     Regular  forms  should  be  filled  out  for  this 
purpose  and  should  be  submitted  to  the  chief  medical  school  in- 
spector of  the  state.     The  latter  official  should  issue  adequate  and 
detailed   instructions    as   to   the   sanitary   maintenance   of   school 
buildings,  and  local  school  trustees  should  be  held  responsible  for 
seeing  that  these  sanitary  and  hygienic  conditions  are  maintained. 

7.  Adequate   and  well-equipped   playgrounds   are  needed   in 
connection  with  each  school  building.     The  present  provision  of 
such  recreation  places  is  totally  inadequate,  and  even  in  those  that 
are  maintained  proper  equipment  is  lacking.      Proper  play   and 
recreation  is  an  important  part  of  the  health  program. 

To  summarize,  the  Committee  feels  that  consolidation  of  rural 
school  districts,  more  adequate  building  programs,  enforcement 
of  the  state  medical  inspection  law  with  regard  for  the  real  spirit 
of  it  rather  than  the  mere  compliance  with  its  form  and  the  provi- 
sion by  local  communities  of  an  adequate  number  of  school  nurses, 
are  vital  and  immediate  needs.  It  urges  the  adoption  of  the  coun- 
ty as  the  unit  of  administration  and  taxation  as  the  most  promising 
means  of  filling  these  needs  in  rural  schools.  An  ideal  system  of 
health  supervision  would  call  for  many  more  recommendations, 
but  the  present  situation  is  so  far  below  the  safety  line  that  the 
Committee  feels  warranted  at  this  time  in  asking  for  only  the  mini- 
mum requirements  of  safety  and  health. 

It  is  within  the  power  of  the  citizens  of  this  state  to  see  that 
the  children  receive  a  square  deal.  Certainly,  New  York  State 
cannot  afford  to  allow  this  present  condition  of  neglect  to  continue. 
The  amount  of  money  that  must  be  expended  in  order  to  provide 

72 


proper  health  care  is  well  within  the  means  of  any  of  the  local 
communities.  The  results  that  may  reasonably  be  expected  from 
such  an  expenditure  are  incalculable.  There  is  no  reason  why 
the  children  of  New  York  State  should  not  be  the  healthiest  in  the 
world.  The  methods  of  assuring  them  good  health  are  simple  and 
can  easily  be  put  into  practice  in  any  community. 


73 


Part  II 

PROVISIONS  FOR  MATERNITY  AND  INFANT  CARE 
THE  PRE-SCHOOL  CHILD 

There  is  an  old  truism,  "Upon  the  health  of  the  child  depends 
the  welfare  of  the  race."  Recognition  of  this  fact  is  practically 
universal  among  us  as  individuals  but  is  only  beginning  to  activate 
us  as  a  social  group.  We  have  made  a  start,  however,  and  this 
newer  way  of  facing  our  problems  is  a  most  hopeful  sign  and  one 
which  is  already  bringing  in  results.  The  second  part  of  this  sur- 
vey is  a  study  of  those  beginnings  of  social  activity  which  indicate 
acceptance  by  our  communities  of  their  responsibility  for  the  pro- 
tection of  mothers  and  infants  and  the  care  of  children  of  pre- 
school age. 

In  the  first  part  of  this  survey  the  unit  of  study  was  the  indi- 
vidual school.  In  this  section,  however,  the  unit  taken  was  the 
civil  division,  and  the  questionnaires  were  prepared  to  cover  all 
types  of  work  which  were  being  carried  on  for  expectant  mothers, 
infants  and  children  of  pre-school  age  in  the  different  cities,  towns 
and  villages  of  the  state. 

The  state  contains  1,441  civil  divisions,  including  58  cities,  450 
incorporated  villages  and  933  townships.  These  are  grouped  in 
57  counties  outside  of  New  York  City.  Because  of  the  large  num- 
ber of  civil  divisions  it  was  found  better  as  a  matter  of  expediency 
to  tabulate  the  material  gathered  under  a  larger  unit  and  the  coun- 
ty was  therefor  selected.  More  and  more  the  form  of  county  organ- 
ization is  being  recognized  as  the  best  that  can  be  obtained  for  the 
rural  districts,  and  even  the  cities,  towns  and  villages  can  find  it  an 
advantage  to  consider  themselves  an  integral  part  of  the  county, 
although  the  work  they  are  carrying  on  may  be  locally  separated. 

The  field  of  work  in  maternity  and  infant  care  in  New  York 
State  is  a  matter  of  much  more  recent  inception  than  the  system  of 
public  schools.  It  varies  widely  in  extent  and  type  in  the  different 
communities.  Great  local  interest  and  much  enthusiasm  have 
caused  the  protection  given  to  mothers  and  babies  to  be  developed 

75 


to  a  most  satisfactory  extent  in  some  communities,  while  in  others, 
lack  of  public  opinion  and  any  functioning  local  organization  has 
meant  that  there  is  practically  no  form  of  infant  and  maternity 
welfare  work  being  carried  on.  There  is  no  uniform  system 
throughout  the  state.  The  type  of  organization  varies  from  that 
which  is  promoted  by  many  well-organized  health  boards  in  the 
large  cities  to  the  almost  universal  dependence  upon  local  private 
or  semi-private  organizations  in  the  rural  communities.  The  State 
Department  of  Health,  through  its  Division  of  Maternity,  Infancy 
and  Child  Hygiene,  provides  supervisory  and  educational  work 
throughout  the  state.  It  has  already  accomplished  a  large  amount 
of  good,  but  its  field  is  almost  unlimited  and  its  appropriation  has 
been  small  and  not  in  any  way  sufficient  to  meet  the  need.  The 
State  Division  of  Maternity,  Infancy  and  Child  Hygiene  has  held 
health  consultations  in  many  places  throughout  the  state  and  has 
maintained  a  health-mobile  which  has  visited  a  number  of  the 
counties.  Their  method  is  usually  to  select  first  one  county  and 
then  another  as  a  unit  for  the  purpose  of  demonstrating  the  value 
of  maternity  and  infant  welfare  work,  the  idea  being  that  the 
counties  thereafter  should  take  over  the  work  and  carry  it  on  at 
their  own  expense. 

The  purpose  of  this  survey  has  been  to  stimulate  interest  IB 
the  work  that  the  State  Department  of  Health  is  doing,  to  obtain 
for  them,  if  possible,  a  larger  appropriation  so  that  their  work 
may  be  made  more  effective  and  to  organize  the  women  of  the 
state  as  an  intelligent  co-operative  group  that  can  be  depended 
upon  by  the  State  Department  of  Health  for  local  assistance.  The 
time  of  publication  of  this  report  has  made  it  possible  to  state 
that  one  of  these  objects,  at  least,  has  been  achieved.  For  during 
1922  the  state  has  appropriated  $160,000  to  be  spent  by  the 
Division  of  Maternity,  Infancy  and  Child  Hygiene  of  the  State 
Department  of  Health.  The  second  object,  that  of  making  many 
women  of  the  state  intelligent  regarding  local  conditions,  is,  we 
believe,  also  to  be  placed  among  the  results  of  the  survey. 

It  must  be  remembered,  however,  that  no  matter  how  extensive 
the  activities  of  the  State  Department  of  Health  may  be,  the  local 
community  must  necessarily  remain  responsible  for  seeing  that 
any  work  suggested  by  the  State  Department  of  Health  is  not  only 
initiated  but  carried  on  and  the  local  community  must  also  have  n 
knowledge  of  these  local  conditions  and  be  able  to  understand 

76 


its  own  most  urgent  needs.  In  the  final  analysis,  the  continued 
health  of  mothers  and  babies  will  depend  upon  it. 

The  position  of  New  York  State  with  regard  to  its  infant  death 
rate  is  not  an  enviable  one.  Of  the  23  states  in  the  birth  registra- 
tion area  of  the  United  States,  New  York  State  stands  eleventh. 
In  1921  the  infant  death  rate  in  New  York  State  was  75.  This 
means  that  of  every  thousand  babies  born  in  the  state  during  that 
year,  75  died.  The  significant  fact,  however,  is  that  the  rate  for 
New  York  City  in  1921  was  71  infant  deaths  per  thousand  births, 
and  for  the  rest  of  the  state  it  was  81  per  thousand  births.  This 
relative  variability  between  the  city  and  the  state  has  been  main- 
tained for  a  number  of  years.  It  seems  evident  that  the  rate  for 
New  York  State  outside  of  New  York  City  should  be  as  low  as  for 
the  city,  and  if  proper  attention  can  be  given  to  the  problems  of 
infant  welfare  in  the  state,  in  all  probability  the  present  death 
rate  can  be  cut  in  half. 

The  low  infant  death  rate  in  New  York  City  can,  to  a  large 
extent,  be  credited  to  the  public  health  work  that  has  been  carried 
on  for  the  past  twelve  years.  In  the  five  boroughs  of  New  York 
City  there  are  104  baby  health  stations  and  59  prenatal  clinics. 
Outside  of  the  city  the  figures  seem  to  be  less  encouraging.  In  43 
other  cities,  towns  and  villages  there  are  one  or  more  prenatal 
clinics  or  health  centers  where  some  prenatal  care  is  given,  but  12 
of  these  are  in  Westchester  and  Nassau  Counties,  leaving  only 
31  communities  with  prenatal  clinics  to  be  distributed  among  the 
remaining  55  counties  of  the  state.  Forty-four  communities  have 
child  welfare  stations  but  no  prenatal  clinics.  Twenty-nine  cities 
make  no  provision  for  the  care  of  expectant  mothers.  In  21 
counties  of  the  state  no  organized  work  whatever  is  being  carried 
on  along  the  lines  of  maternity  and  infant  hygiene.  There  are 
public  health  nurses  in  most  of  these  counties  but  their  time  is 
taken  up  with  other  duties  such  as  tuberculosis  work  or  visiting 
the  schools.  In  Franklin  County,  which  in  1920  had  an  infant 
mortality  rate  of  120 — the  highest  in  the  state — there  is  no  public 
health  nurse  giving  any  time  to  infant  welfare  work  and  there  are 
no  child  welfare  stations.  In  1921  Hamilton  County  had  an  infant 
death  rate  of  164  and  a  similar  situation  existed,  that  is,  no  infant 
welfare  work  was  being  carried  on  in  that  county  during  thaf 
time. 

It  is  recognized  that  in  many  of  these  counties  with  a  scattered 

77 


population,  the  best  type  of  work  is  that  of  establishing  a  visiting 
nurse  system  rather  than  through  attempting  to  organize  one  or 
more  child  welfare  stations.  Nevertheless,  at  the  present  time, 
there  can  be  no  excuse  for  any  county  failing  to  recognize  its 
responsibilities  in  this  direction  and  providing  the  necessary  care 
for  its  mothers  and  children. 

The  State  Department  of  Health  has  published  the  following 
interesting  statement  of  statistics  with  regard  to  the  maternal  and 
infant  death  rates  of  1921: 

"In  1921  there  occurred  in  the  entire  State  of  New  York  1,382  deaths 
of  mothers  from  causes  connected  with  childbirth;  of  these  398  died 
from  puerperal  poisoning.  From  the  latter  condition,  that  in  the 
majority  of  instances  is  preventable,  there  occurred  225  deaths  in  the 
State  of  New  York  outside  of  New  York  City  and  408  deaths  from  all 
other  maternal  causes. 

"In  the  State,  outside  New  York  City,  the  chief  cause  of  death  in 
children  under  one  year  of  age  was  premature  birth  and  the  second  in 
importance  was  gastro-intestinal  diseases,  chiefly  from  diarrhoea  and 
enteritis,  an  ailment  that  is  preventable  and  often  curable.  Out  of  a 
total  of  8,464  babies  who  died  under  one  year  of  age  in  the  up-state 
area,  2,170  or  26  per  cent,  died  as  the  result  of  premature  birth  and 
1,746  or  21  per  cent,  died  from  gastro-intestinal  diseases.  Next  in 
importance  were  the  respiratory  diseases  that  caused  11  per  cent,  of 
the  infant  deaths;  these  diseases  include  chiefly  tuberculosis,  bronchitis 
and  pneumonia.  Out  of  the  8,464  children  who  died  in  the  State  in 
1921,  outside  of  New  York  City,  4,681  or  over  one-half  did  not  live 
through  the  first  month  of  life.  In  fact,  of  all  the  children  2,008  or  24 
per  cent,  did  not  live  through  the  first  day  of  life  and  4,124  or  about 
one-half  did  not  finish  their  first  two  weeks  of  life.  This  makes  it  clear 
that  the  dangers  to  the  newborn  child  are  greatest  immediately  after 
it  is  born,  its  security  from  sickness  and  death  becoming  greater  with 
each  day  that  it  lives.  Therefore  efforts  to  prevent  this  loss  of  child 
life,  to  be  highly  effective,  should  begin  with  the  mothers  before  the 
children  are  born,  and  painstaking  care  must  be  given  the  newborn 
child  during  the  first  few  days  and  weeks  of  its  life." 

Because  this  question  must  necessarily  be  a  local  one  and 
because  each  community  must  be  responsible  for  conditions  found 
within  its  own  borders,  it  has  seemed  wise  to  give  a  separate, 
detailed  account  of  conditions  found  in  each  county  of  the  state 
in  addition  to  the  final  tabulated  and  summarized  report. 

The  points  taken  up  in  the  second  questionnaire  cover  such 
topics  as  health  supervision  for  expectant  mothers  through  clinics, 
health  centers  or  home  visits  by  nurses;  provision  for  hospital 

78 


care  for  obstetrical  cases  and  for  nursing  care  at  home:  milk 
supply;  number  and  activity  of  public  health  nurses;  child  wel- 
fare stations,  day  nurseries  and  playgrounds  for  pre-school  chil- 
dren. These  subjects  are  covered  in  great  detail  in  the  following 
series  of  questions. 


QUESTIONNAIRE  NO.  2 

PRENATAL  CARE,  CARE  AT  BIRTH,  CARE  OF  THE  INFANT  AND  CHILD 
OF  PRE-SCHOOL  AGE 

Name   of   Investigator? 

Address? 

City,  Town  or  Village? 

County? 

I.  PRENATAL  CARE. 

A.  Is  any  health  supervision  given  to  expectant  mothers? 

1.  Through   what   organization? 

a.  Are  its  activities  statewide,  or  confined  to  city,  township 

or  village? 
b.    Is  organization  supported  by  public  or  private  funds? 

2.  Is  the  care  given  in  clinics  or  health  centers? 

3.  Is  the  care  given  by  home  visiting? 

4.  Are  physical  examinations  made? 

5.  How   are   expectant   mothers   persuaded  to   take   advantage   of 

this  supervision? 
a.    How  is  contact  made  with  them? 

6.  How  many  women  were  reached  last  year? 

7.  Are  all  women  who  cannot  secure  a  private  physician  cared 

for? 

8.  Are  women  in  remote   sections  reached? 

B.  Is  any  educational  work  done? 

1.  By  printed  matter  sent  out  giving  simple  instructions? 

a.  Through  what  organization? 

b.  Paid  for  by  public  or  private  funds? 

2.  Through  visiting  nurses? 

3.  Any  other  way? 

C.  .Is  any  protection  given  by  local  interests  to  expectant  mothers  in 

industry?     (No  State  Law  provides  for  this.) 

1.  Maternity  insurance? 

2.  Maternity  benefit? 

D.  If  no  prenatal  care  is  being  given,  has  any  attempt  ever  been  made 

to  inaugurate  such  work? 

1.  By  whom? 

2.  Why  did  it  fail? 

II.  CARE  AT  BIRTH. 

(During  the  war  there  were  approximately  the  same  number  of 
deaths  from  child  birth  as  there  were  soldiers  killed  in  action.  Annually 
in  the  United  States  there  are  about  25,000 — half  are  preventable.) 

79 


A.  How  many  hospitals  take  obstetrical  cases? 

1.  Number  of  beds? 

2.  Number  of  cases  cared  for  last  year? 

3.  Are  more  beds  needed? 

B.  How   many   hospitals    or    dispensaries    send    physicians   to   deliver 

women  in  their  own  homes? 

1.  Number  of  cases  last  year? 

C.  Are  there  sufficient  physicians  available  for  rural  calls? 

2.  Have  you  heard  of  any  cases  where  physicians  could  not  be 

obtained? 

D.  Is  there  any  provision  for  nursing  care  at  confinement  in  homes? 

E.  Is   there   any  provision  for   domestic  help  to  poor  mothers   during 

period    of    confinement? 

F.  Number  of  maternity  homes? 

1.  Are  they  licensed   and   supervised  by  the   health   authorities? 

2.  Number  of  cases  last  year? 

G.  How  many  midwives  are  registered  with  the  local  registrar  of  vital 

statistics? 

1.  Are  they  all  licensed  by  the  State  Commissioner  of  Health? 

(Required  by  law.) 

2.  Are  midwives  prosecuted  for  practicing  illegally? 

a.     Number  prosecuted  last  year? 

3.  Is  supervision  given  by  State  or  local  authorities? 

a.     By  Police. Department? 

4.  Is    educational    training    available    for    women    who    wish    to 

become  midwives? 

H.     Can  sterile  supplies  for  labor  be  obtained  at  small  cost? 
I.       Care  of  babies'  eyes: 

1.  Is  silver  nitrate  solution  furnished  without  charge  by  Health 

Department? 

2.  Are  cases  of  babies'  "sore  eyes"  reported  promptly? 

III.     CARE  OF  THE  INFANT  (BIRTH  TO  Two  YEARS)  AND  CHILD  OF 
PRE-SCHOOL  AGE. 

A.  Milk  supply. 

1.  What  grades  of  milk  do  you  have? 

a.  Certified? 

b.  Grade  A?  Raw?  Pasteurized? 

c.  Grade   B?  Raw?  Pasteurized? 

d.  Grade   C?  Raw?  Pasteurized? 

2.  Is  milk  for  retail  trade  always  sold  in  bottles? 

3.  Have  you  milk  stations  which  supply  milk  free  or   at  small 

cost? 

a.    How  many? 

B.  Public  Health  Nurses. 

(The  term,  Public  Health  Nurse,  as  used  here  refers  to  a  person 
who  is  essentially  a  teacher  of  hygiene  and  preventive  medicine  and 
who  does  no  bedside  nursing  except  for  demonstration  or  -in 
emergencies.) 

1.  How  many  nurses  have  you  for  infant  work? 

a.  Full  time? 

b.  Part  time?  Number  of  hours  per  week? 

c.  Do   the   same   nurses   have   supervision    of    children    of 

pre-school  age? 

2.  Have  you  special  nurses  for  children  of  pre-school  age? 

a.    How  many? 

3.  Do  they  visit  well  children  or  only  sick  ones? 

4.  What  organizations  employ  your  nurses? 

80 


a.  Department  or  Board  of  Health? 

b.  Red  Cross? 

c.  State  Charities  Aid? 

d.  Visiting  Nurses  Association? 

e.  Life  Insurance  Companies? 

f.  Any  others? 

C.  Child  Welfare  Stations  or  Health  Centers. 

1.  How  many  have  you? 

2.  Children  of  what  ages  are  admitted? 

a.     Is  the  attendance  largely  of  infants  or  older  children? 

3.  Number  of  children  attending  last  year? 

4.  Under  what  supervision? 

a.  Department  of  Health? 

b.  Associated  Charities? 

c.  Other    organizations? 

(1)     How  are  funds  secured? 

5.  Is  a  physician  employed? 

6.  Is  a  nurse  employed? 

a.    How  many? 

7.  Are  records  kept? 

8.  Is  provision  made  for  the  correction  of  physical  defects? 

a.  Who  carries  on  this  follow-up  work? 

b.  Are    there    sufficient    clinical   facilities   for    treat- 

ment? 

9.  Are  volunteer  workers  used? 

a.  If  not,  would  organization  accept  such  aid? 

b.  What  suggestions  can  you  make  as  to  type  of  vol- 

unteer work  that  would  be  most  efficient? 

D.  Educational  Work. 

1.  Little  Mothers'  Leagues. 

(Little  Mothers'  Leagues  are  groups  of  young  girls  over 
twelve  years  of  age  who  are  taught  personal  hygiene  and 
methods  of  baby  care.  They  are  under  the  direction  of  the 
State  Department  of  Health.) 

a.    Have  you  any  such  leagues? 

(1)  If  not,  is  your  community  of  a  type  that  would 
make  it  desirable  to  form  one? 

2.  Are  methods  of  baby  care  popularized  in  any  other  way? 

a.  Through  Children's  Health  Consultations? 

b.  Through  local  newspapers  or  magazines? 

c.  By  child  welfare  exhibits? 

d.  By  special  pamphlets  distributed? 

e.  By  lectures? 

f.  Any  other  way? 

3.  What  organizations  are  supporting  educational  work? 

4.  Are  mothers  taught  the  importance  of  avoiding  communicable 

diseases? 

a.     By  whom? 

(About  90%  of  all  cases  of  contagious  disease  occur  in 
children  under  five  years  of  age  and  80%  of  deaths  from 
this  cause  occur  during  this  age  period.) 

E.  Dietitions  and  Nutrition  Workers: 

1.  How  many  are  employed? 

2.  Do  they  instruct  mothers  in  feeding  children? 

3.  What  organizations  employ  them? 

a.    Public  or  private? 

4.  Do  they  reach  women  in  rural  homes? 

5.  If  none  are  employed,  does  nurse  give  this  instruction? 

81 


F.  Day  Nurseries: 

1.  How  many  have  you? 

2.  How  many  children  do  they  care  for  annually? 

a.     What  ages  are  admitted? 

3.  Do  they  have  permits  from  the  Board  of  Health? 

4.  Are  they  supervised  by  a  trained  nurse  or  physician? 

5.  Are  the  children  examined  by  a  physician  before  admission? 

6.  How  are  the  nurseries  supported? 

7.  Is  any  charge  made  for  taking  children? 

G.  Playgrounds. 

1.  How  many  playgrounds  are  open  to  children  under  five  years 

of  age? 

2.  Are    there   enough   to    care   for   all    children   who   need   play- 

grounds? 

3.  Are  they  supported  by  public  or  private  funds. 

4.  Is  the  play  supervised? 

a.     By  whom? 

5.  Are  games  taught? 

6.  Is  there  any  opportunity  for  volunteer  work? 

a.  Is  it  difficult  to  obtain  such  assistance? 

b.  Could    the    efficiency    of   the    recreational   work    be    in- 

creased by  volunteer  assistance? 

Tables  4,  5,  6  and  8  give  the  data  gathered  from  these  question- 
naires, and  the  findings  are  also  indicated  on  the  map  on  page  74. 
We  succeeded  in  gathering  information  from  each  of  the  1,441 
civil  divisions  in  the  state  through  our  county  committees,  so  the 
figures  given  in  the  tables  and  the  picture  presented  by  the  map 
represent  fairly  accurately  and  with  very  few  omissions  conditions 
as  they  exist  throughout  the  state. 


MATERNITY  AND  INFANCY  HYGIENE  IN  INDIVIDUAL 

COUNTIES 

ALBANY  COUNTY 

Contains  17  civil  divisions  (three  cities,  10  townships  and 
four  incorporated  villages)  and  has  a  total  population  of  179,575. 
Its  rural  infant  mortality  rate  in  1921  was  92.  In  Albany  City  it 
was  78  and  in  Cohoes  109.  The  only  provisions  for  prenatal, 
maternal,  and  infant  care  in  the  County  are  in  Albany,  Cohoes  and 
Colonie  township. 

Prenatal  clinics  are  held  in  Albany  Hospital  and  the  Homeo- 
pathic Hospital,  and  social  workers  get  in  personal  touch  with 
prospective  patients.  Three  hospitals  in  the  City  of  Albany  take 
obstetrical  cases  and  a  total  of  1,040  were  cared  for  last  year. 
The  Albany  Hospital  has  just  started  a  delivery  service  to  attend 
patients  in  their  homes  and  nursing  care  is  provided  by  the 

82 


Albany  Guild  of  Public  Health  Nurses.  Seven  midwives  are  regis- 
tered. Domestic  help  is  given  through  the  Catholic  Charities  Aid 
and  the  Associated  Charities.  The  Brady  Maternity  Hospital 
cared  for  282  infants  last  year  until  they  were  weaned  and  their 
mothers  were  provided  with  work,  etc.  Two  public  health  nurses 
devote  their  full  time  to  infant  work  and  two  child  welfare  sta- 
tions had  an  attendance  of  1,988  last  year.  Educational  work 
is  carried  on  in  many  ways,  notably  by  five  Little  Mothers'  Leagues, 
which  granted  diplomas  to  75  children,  by  special  pamphlets, 
exhibits,  newspaper  articles,  etc.  The  Christian  Mothers'  Union 
in  the  South  End  Dispensary,  the  Red  Cross,  the  City  and  State 
Department  of  Health,  the  Metropolitan  Life  Insurance  Co.,  and 
the  Children's  Bureau  are  supporting  educational  work.  There 
is  a  nutrition  class  in  the  South  End  Dispensary.  Two  day 
nurseries  care  for  5,240  children.  Five  playgrounds  are  open  to 
children  under  five  years  of  age. 

Cohoes  gives  health  supervision-  to  expectant  mothers  through 
a  clinic  and  educational  work  is  carried  on  by  the  Red  Cross.  One 
full  time  public  health  nurse  is  employed  by  the  Board  of  Health 
for  infant  work.  There  is  one  child  welfare  station.  Educa- 
tional work  is  being  done  through  Little  Mothers'  Leagues,  news- 
papers, exhibits,  children's  health  consultations,  etc.  There  is 
one  day  nursery,  and  three  playgrounds  are  open  to  children  of 
pre-school  age. 

In  Colonie  township  a  nurse  for  infant  work  is  employed  by 
the  Red  Cross  and  she  also  gives  some  supervision  to  expectant 
mothers.  Cases  needing  it  are  taken  to  clinics  in  Albany. 

Throughout  the  rest  of  the  county  practically  nothing  is  being 
done  except  the  work  of  a  county  nutritionist  employed  by  the 
Red  Cross  and  two  single  clinics  held  for  children  in  Watervliet. 
Some  prenatal  work  was  attempted  in  Altamont  and  a  public 
health  nurse  was  employed  but  she  was  withdrawn. 

ALLECHANY  COUNTY 

Contains  40  Civil  Divisions  (29  townships  and  11  incor- 
porated villages),  and  has  a  total  population  of  40,216.  Its 
infant  mortality  rate  in  1921  was  87. 

No  work  is  being  carried  on  in  the  county  which  is  primarily 
directed  towards  lessening  the  risk  of  maternity  and  lowering 
the  infant  death  rate.  There  is  no  maternity  hospital  and  no 

84 


health  supervision  is  given  to  expectant  mothers.  A  new  general 
hospital  is  just  being  opened  in  Wellsville,  which  will  have 
seven  beds  for  obstetrical  cases.  Formerly  only  emergency  cases 
were  taken.  A  little  educational  work  is  carried  on  through  the 
efforts  of  the  Home  Bureau  and  the  State  Department  of  Health. 
There  is  a  community  nurse  in  Alfred,  a  school  nurse  in  Wells- 
ville and  a  Red  Cross  nurse  in  Bolivar,  but  they  are  occupied  with 
other  duties.  There  is  a  shortage  of  physicians  throughout  the 
country. 

BROOME  COUNTY 

Contains  25  Civil  Divisions  (one  city,  16  townships  and 
eight  incorporated  villages),  and  has  a  total  population  of  85,860. 
Its  infant  mortality  rate  for  the  rural  area  in  1921  was  79  and  for 
Binghamton  was  82. 

Health  supervision  is  provided  for  infants  and  expectant 
mothers  in  the  city  of  Binghamton.  This  is  given  both  through 
clinics  and  home  visiting  by  child  welfare  nurses.  There  are  foui 
hospitals  in  Binghamton  taking  obstetrical  cases,  one  in  Johnson 
City,  one  in  Endicott,  and  one  in  Union.  It  is  reported  that  more 
beds  for  maternity  cases  are  needed  in  the  city  of  Binghamton. 
There  is  a  supervised  maternity  home  licensed  by  the  health 
authorities.  Nine  midwives  are  registered. 

There  are  eight  nurses  in  Binghamton  giving  full  time  to  infant 
care  and  the  care  of  pre-school  children.  There  are  public  health 
nurses  in  Union,  Johnson  City,  Windsor  and  Deposit  and  some 
time  is  given  by  them  to  infant  work. 

Five  child  welfare  stations  are  located  in  Binghamton  taking 
children  from  three  months  to  six  years.  There  is  one  in  John- 
son City,  one  in  Windsor  and  one  in  Endicott. 

A  nutrition  worker  is  employed  by  the  Red  Cross  and  the 
Broome  County  Health  Association,  who  instructs  mothers  in 
feeding  of  children. 

There  are  two  day  nurseries  in  the  city  of  Binghamton  which 
care  for  about  5,000  children  annually.  These  nurseries  are  sup- 
ported by  the  Humane  Society. 

CATTARAUGUS  COUNTY 

Contains  50  Civil  Divisions  (two  cities,  32  townships,  and 
13  incorporated  villages)  and  has  a  total  population  of  66,122. 

85 


Its  rural  infant  mortality  rate  in  1921  was  77,  in  Olean  it  was  81 
and  in  Salamanca  95. 

The  only  work  organized  primarily  for  the  care  of  expectant 
mothers  during  pregnancy  and  confinement  and  for  the  care  of 
infants  is  limited  to  the  city  of  Olean,  where  there  is  a  health 
center  supported  by  the  Red  Cross,  which  examined  and  gave 
advice  to  172  women  last  year.  Two  hospitals 'in  the  city  take 
obstetrical  cases  and  one  is  being  enlarged.  The  Red  Cross  pro- 
vides nursing  care  and  domestic  help  to  poor  women  during  con- 
finement. One  midwife  is  licensed  in  the  city.  Two  Red  Cross 
nurses  give  part  time  to  infant  work.  There  is  one  child  welfare 
station  supported  by  the  Red  Cross  at  which  there  was  an  attend- 
ance last  year  of  427.  Educational  work  is  being  done  through 
the  board  of  health  nurse,  the  Anti-Tuberculosis  Society  and  the 
Red  Cross,  and  two  Little  Mothers'  Leagues  have  been  formed. 
There  are  seven  playgrounds  open  to  children  of  pre-.:chool  age. 

Salamanca  contains  a  hospital  which  admits  obstetrical  cases. 

Two  townships,  Franklinville  and  Gowanda,  have  public  health 
nurses  who  give  some  supervision  to  expectant  mothers  through 
home  visiting.  The  contact  with  them  is  made  through  the  school 
children.  There  is  a  baby  welfare  station  in  Gowanda  for  weigh- 
ing and  measuring.  There  is  a  shortage  of  physicians  for  rural 
work  and  cases  have  been  reported  from  Great  Valley  and  Lime- 
stone where  no  physicians  could  be  obtained.  A  county  tubercu- 
losis nurse  helps  with  the  educational  work. 

CAYUGA  COUNTY 

Contains  33  Civil  Divisions  (one  city,  23  townships,  and 
nine  incorporated  villages) ,  and  has  a  total  population  of  67,741. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  70, 
and  in  Auburn  73. 

There  is  no  organized  prenatal  work  in  the  county,  but  some 
supervision  is  given  to  expectant  mothers  through  home  vi-iting 
in  Auburn  and  in  Brutus  township,  including  Weedsport.  In  the 
city  this  work  is  done  by  the  visiting  nurse  of  the  City  Hospital 
and  in  Brutus  by  the  nurse  employed  by  the  Red  Cross  and 
Metropolitan  Life  Insurance  Company.  Six  midwives  are  regis- 
tered in  Auburn.  One  hospital  takes  obstetrical  cases  and  cared 
for  262  women  last  year,  but  it  has  no  outside  delivery  service. 
One  case  was  reported  in  which  no  physician  could  be  obtained. 

86 


The  city  nurse  visits  needy  mothers  during  the  period  of  their 
confinement.  There  are  also  two  maternity  homes.  A  small  hospi- 
tal in  Genoa  takes  obstetrical  cases.  There  is  a  maternity  home 
in  Weedsport  which  accepts  women  from  Brutus  township,  and 
cared  for  eight  cases  last  year. 

There  are  two  child  welfare  stations  in  Auburn  with  physi- 
cians in  attendance,  one  of  which  is  open  in  Summer  only.  These 
are  supported  by  funds  raised  through  the  Neighborhood  House 
and  Parent  Teachers  Association  and  Red  Cross.  Six  nurses  in 
Auburn  give  part  of  their  time  to  infant  work,  but  this  consists 
chiefly  in  caring  for  sick  children  rather  than  in  preventive  work. 
A  child  welfare  station  is  also  open  for  the  children  of  Brutus 
township  and  Weedsport.  A  nurse  is  in  attendance  and  the 
expenses  are  paid  by  the  Red  Cross,  the  Metropolitan  Life  Insur- 
ance Company  and  the  Board  of  Education.  One  milk  station  is 
open  in  Auburn  during  the  summer.  Grade  A  milk  is  produced 
in  Auburn  and  certified  milk  can  be  obtained  from  Syracuse  for 
those  who  can  afford  to  pay  for  it,  but  dip  milk  is  still  being 
peddled  in  the  city.  One  nutrition  worker  is  employed  by  the 
Red  Cross  to  do  educational  work.  One  day  nursery  admits  chil- 
dren between  one  and  twelve  years  of  age  and  has  an  average 
daily  attendance  of  28.  There  are  eight  playgrounds  which  admit 
children  of  pre-school  age.  They  would  be  glad  to  use  volunteer 
assistants  to  teach  games,  etc.  There  are  also  two  playgrounds  in 
Port  Byron. 

A  certain  amount  of  educational  work  is  carried  on  through  a 
few  of  the  other  townships  and  villages  through  the  activities  of 
the  Home  Bureau  and  the  Child  Welfare  Committee. 

CHAUTAUQUA  COUNTY 

Contains  41  Civil  Divisions  (two  cities,  26  townships  and 
14  incorporated  villages),  and  has  a  total  population  of  117,397. 
Its  infant  mortality  rate  in  rural  districts  in  1921  was  66,  in  Dun- 
kirk 82,  and  in  Jamestown  71. 

In  the  two  cities  of  this  county,  Jamestown  and  Dunkirk, 
and  in  one  village,  Fredonia,  organized  work  is  carried  on  along 
the  lines  of  maternity  and  infant  hygiene.  Elsewhere  in  the  county 
practically  nothing  is  being  done. 

Jamestown  maintains  a  health  center  where  supervision  is 
given  to  expectant  mothers  through  the  Visiting  Nurses  Associa- 

87 


tion,  and  also  provides  for  home  visiting — 128  women  were  reached 
last  year.  It  has  two  hospitals  which  provide  thirty  beds  for 
obstetrical  cases,  but  which  make  no  provision  for  outside  deliv- 
eries. Four  midwives  are  registered  in  the  city.  There  is  a  child 
welfare  station  which  has  two  children's  clinics  and  one  well  baby 
clinic  and  which  had  an  attendance  of  393  last  year.  Four  nurses 
give  part  time  to  infant  work  and  twelve  physicians  volunteer 
their  services.  Little  Mothers'  Leagues  have  been  formed  in 
Jamestown  and  educational  work  has  been  carried  on  through 
child  health  improvement  contests.  One  day  nursery  cares  for 
35  children  daily.  Eight  playgrounds  are  open  to  children  of 
pre-school  age. 

In  Dunkirk  health  supervision  is  given  to  expectant  mothers 
through  a  health  center  maintained  by  the  Red  Cross  and  Anti- 
Tuberculosis  Society  and  about  40  women  were  reached  last  year. 
Some  home  visiting  is  also  done.  In  the  same  building  there  is 
a  child  welfare  station  for  infants  and  children  of  pre-school  age, 
with  a  clinic.  The  physicians'  services  are  volunteered.  One 
nurse  gives  full  time  to  work  with  infants  and  children  of  pre- 
school age  and  350  children  attended  the  clinic  last  year.  A  day 
nursery  is  housed  in  the  same  building  and  had  3,482  admissions 
last  year  of  children  between  six  months  and  ten  years  of  age. 
There  is  a  small  playground  in  connection  with  the  day  nursery. 
One  hospital  has  14  beds  for  obstetrical  cases,  but  has  no  outside 
delivery  service.  There  is  no  provision  for  nursing  care  nor 
domestic  help  for  poor  women  during  confinement.  Six  mid- 
wives  are  registered  and  licensed. 

In  Fredonia  occasional  health  supervision  is  given  to  expectant 
mothers  through  the  public  health  nurse  from  the  health  center 
which  was  started  by  the  County  Tuberculosis  Society  and  is 
maintained  by  public  funds  and  the  Red  Cross.  Eighty  children 
attended  the  health  center  clinics.  One  nuree  is  employed  and 
the  physician's  services  are  volunteered. 

Except  for  some  general  educational  work  carried  on  through 
the  Anti-Tuberculosis  Society,  the  Red  Cross  and  the  Health  De- 
partment, nothing  else  is  being  done  along  these  lines  in  the 
county. 

CHEMUNG  COUNTY 

Contains    16   civil    divisions    (one   city,    11    townships,    and 

88 


four  incorporated  villages),  and  has  a  total  population  of  55,099. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  86,  and 
in  Elmira  65. 

There  are  no  prenatal  clinics  nor  child  welfare  stations  in  the 
county.  In  Elmira  there  are  three  visiting  nurses  doing  bedside 
work,  and  they  gave  some  supervision  to  about  sixty  expectant 
mothers  last  year.  There  are  five  hospitals  in  the  city  and  about 
625  maternity  cases  were  cared  for  last  year.  The  day  nursery 
during  the  past  year  has  reached  forty -three  families.  Children 
from  seven  weeks  to  seven  years  are  admitted. 

A  splendid  piece  of  demonstration  work  in  maternity  hygiene 
is  being  done  by  the  county  public  health  nurse  employed  by  the 
Red  Cross;  56  visits  were  made  by  this  nurse  in  all  parts  of  the 
county  for  supervision  of  expectant  mothers  and  20  cases  were 
cared  for.  Ten  cases  were  not  attended  by  a  doctor  because  of 
lack  of  money  to  secure  one. 

Neither  the  city  nor  the  county  employ  nurses  for  infant  work 
or  for  children  of  pre-school  age.  Policy  holders  in  the  Metropoli- 
tan Life  Insurance  Company  have  the  services  of  a  visiting  nurse 
for  five  weeks  after  confinement. 

CHENANGO  COUNTY 

Contains  29  civil  divisions  (one  city,  20  townships  and  eight 
incorporated  villages) ,  and  has  a  total  population  of  36,648.  Its 
infant  mortality  rate  for  the  rural  sections  in  1921  was  61  and 
for  the  city  of  Norwich  76. 

There  is  practically  no  supervision  of  maternity  and  infant 
hygiene  throughout  this  county.  A  little  educational  work  is  being 
done  by  the  Red  Cross  organization.  Two  hundred  and  fifty 
women  took  the  home  nursing  lessons  taught  by  the  Red  Cross 
nurse  last  year.  The  city  nurse  in  Norwich  can  only  touch  this 
work,  as  her  duties  are  so  numerous. 

A  hospital  in  Norwich  provides  six  beds  for  maternity  cases. 
There  are  no  child  welfare  stations. 

CLINTON  COUNTY 

Contains  19  Civil  Divisions  (one  city,  14  townships  and  four 
incorporated  villages),  and  has  a  total  population  of  48,815.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  114,  and 
in  Plattsburg  106. 

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The  only  provision  in  the  county  for  supervision  of  expectant 
mothers  is  in  the  city  of  Plattsburg  under  the  direction  of  the 
child  welfare  station.  A  clinic  is  held  and  the  nurse  does  some 
home  visiting.  Educational  work  is  being  done  also  by  the  Red 
Cross.  There  are  two  hospitals  in  Plattsburg  which  provide  12 
beds  for  maternity  cases. 

One  nurse  is  employed  for  infant  work  and  she  also  has  the 
supervision  of  children  of  pre-school  age.  The  Board  of  Health, 
the  Red  Cross  and  Metropolitan  Life  Insurance  Company  con- 
tribute funds  for  public  health  nursing. 

The  child  welfare  station  in  Plattsburg  has  in  attendance  chil- 
dren from  birth  to  school  age,  an  average  of  100  a  year.  Educa- 
tional work  is  being  done  through  Little  Mothers'  Leagues.  Child 
health  consultations  have  been  held  and  child  welfare  exhibits. 

COLUMBIA  COUNTY 

Contains  23  Civil  Divisions  (one  city,  18  towns  and  four 
incorporated  villages),  and  has  a  total  population  of  43,983.  Its 
infant  mortality  rate  in  rural  districts  in  1921  was  62  and  in 
Hudson  61. 

Supervision  for  expectant  mothers  is  provided  in  Hudson.  A 
clinic  is  held  at  the  public  health  center  and  care  is  also  given 
by  home  visiting.  Educational  work  is  carried  on  by  the  Red 
Cross  and  the  school  nurse  in  the  village  of  Chatham.  The  office 
of  the  school  nurse,  located  at  the  school  building,  is  sometimes 
used  as  a  clinic.  The  village  of  Philmont  employs  one  public  health 
nurse,  who  is  able  to  give  some  attention  to  expectant  mothers 
while  on  her  other  duties.  The  State  Charities  Aid  executive 
while  traveling  about  the  county  is  often  able  to  distribute  pam- 
phlets and  literature. 

A  hospital  taking  maternity  cases  is  located  in  Hudson,  but 
it  only  has  three  beds  for  this  service.  One  nur^e  in  Hudson  gives 
part  time  to  infant  work,  and  there  is  one  child  welfare  station 
where  infants  are  admitted.  A  physician  gives  his  services  free. 
A  Little  Mothers'  League  has  been  organized  in  the  city. 

CORTLAND  COUNTY 

Contains  16  Civil  Divisions  (one  city,  16  townships  and 
three  incorporated  villages) ,  and  has  a  total  population  of  30,469. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  34,  and 
in  Cortland  66. 

90 


The  city  of  Cortland  has  just  inaugurated  a  plan  of  work  for 
expectant  mothers  and  infants  under  the  direction  of  the  board 
of  health.  A  clinic  is  held  once  a  week  at  the  day  nursery.  The 
city  health  officer  advises  the  mothers  and  examines  the  babiee. 
Owing  to  lack  of  room,  only  eight  babies  can  be  seen  at  each  time. 
About  fifty  babies  have  been  examined  since  the  work  has  been 
started. 

The  county  hospital  located  in  the  city  of  Cortland  has  an 
average  of  100  obstetrical  cases  a  year.  A  new  maternity  ward  is 
being  opened  which  has  21  beds. 

The  city  nurse  is  employed  for  infant  work  as  well  as  for  other 
public  health  work.  The  Child  Welfare  Committee  and  the 
Women's  Club  have  been  very  active  in  educational  work  and 
have  popularized  more  efficient  methods  of  baby  care.  The  county 
committee  for  the  prevention  of  tuberculosis  and  the  Red  Cross 
organization  have  also  been  active  in  educational  work.  The 
County  Home  Bureau  is  interested  in  nutrition  work  and  is  in- 
structing mothers  of  rural  communities  in  more  healthful  feeding 
of  children. 

DELAWARE  COUNTY 

Contain  29  Civil  Divisions  (19  townships  and  10  incorpo- 
rated villages) ,  and  has  a  total  population  of  45,995.  Its  infant 
mortality  rate  in  1921  was  64. 

The  only  attempt  at  supervision  of  maternity  and  infant 
hygiene  is  being  carried  on  by  the  Red  Cross  organization.  Seven- 
teen expectant  mothers  have  been  reached  through  home  visiting. 
There  are  no  clinics,  but  educational  work  is  being  done  through 
the  County  Tuberculosis  Committee,  the  Red  Cross,  and  the  various 
health  boards.  There  is  no  public  hospital  in  the  county  taking 
obstetrical  cases.  A  small  private  hospital  in  Delhi  accommodated 
a  few  cases  during  the  past  year. 

There  are  public  health  nurses  under  the  supervision  of  the 
Red  Cross  in  the  towns  of  Delhi,  Deposit,  Hancock  and  Walton 
who  are  each  able  to  give  some  attention  to  infant  work,  but  there 
are  no  child  welfare  stations  or  health  centers  in  the  county. 
Child  health  consultations  have  been  held  and  special  pamphlets 
on  infant  care  are  distributed  by  health  officers. 

The   Home   Bureau   employs   nutrition  workers   who  instruct 

91 


mothers  in  better  methods  of  feeding  children,  and  women  in  rural 
homes  are  reached  through  these  classes. 

DUTCHESS  COUNTY 

Contains  32  Civil  Divisions  (two  cities,  19  townships  and 
11  incorporated  villages) ,  and  has  a  total  population  of  92,034. 
Its  rural  infant  mortality  rate  in  1921  was  81;  in  Poughkeepsie  it 
was  70,  and  in  Beacon  75.  This  county  is  exceptional  in  that  a* 
many  as  10  out  of  32  Civil  Divisions  have  some  organized  work 
along  the  lines  of  maternity  and  infant  hygiene. 

The  Poughkeepsie  Board  of  Health  maintains  a  clinic  for  ex- 
pectant mothers  and  gave  supervision  to  43  women  last  year.  It 
also  reaches  women  through  home  visiting.  Three  hospitals  cared 
for  324  obstetrical  cases  last  year  in  their  wards,  but  they  have 
made  no  provision  for  outside  deliveries.  Seven  midwives  are 
registered  in  the  city.  The  milk  supply  is  excellent,  conforming 
in  every  way  to  the  standards  set  by  the  State  Commission.  Three 
public  health  nurses  give  full  time  to  work  for  infants  and  chil- 
dren of  pre-school  age.  The  salaries  of  five  nurses  are  paid  by  the 
Board  of  Health,  one  by  the  Visiting  Nurses  Association,  and  one 
by  the  Red  Cross  and  the  Metropolitan  Life  Insurance  Company. 
There  are  also  two  school  nurses.  Three  child  welfare  stations 
had  an  attendance  of  1,708  children  last  year,  most  of  them 
infants.  There  are  three  Little  Mothers'  Leagues.  Two  dietitians 
are  employed  by  the  Tuberculosis  Association  and  the  Associated 
Charities.  One  day  nursery  supported  by  private  funds  admitted 
5,219  children  last  year  and  six  playgrounds  are  open  to  children 
of  pre-school  age. 

Beacon  has  one  public  health  nurse  employed  by  the  city.  She 
is  able  to  give  some  supervision  to  expectant  mothers  through 
home  visiting  in  addition  to  her  other  duties.  There  is  one  hos- 
pital which  cares  for  only  a  few  private  obstetrical  cases.  Two 
midwives  are  registered.  There  are  no  child  welfare  stations. 
Little  Mothers'  Leagues  have  been  formed  and  educational  work 
is  carried  on  through  children's  health  consultations,  child  welfare 
exhibits,  and  literature  which  is  distributed.  Three  playgrounds 
are  open  to  children  of  pre-school  age. 

There  are  five  township  nurses,  in  East  Fishkill,  Poughkeepsie, 
Red  Hook,  Wappinger  and  Washington.  They  give  some  super- 
vision to  expectant  mothers  through  home  visiting  and  each  one 

92 


reached  from  24  to  45  women  last  year.  They  do  bedside  nursing 
as  well  as  educational  work.  The  nurse  in  East  Fishkill  held  a 
well  baby  clinic.  In  Poughkeepsie  township  12  girls  were  enrolled 
in  the  Little  Mothers'  League  and  educational  work  was  also  car- 
ried on  through  children's  consultations.  Four  midwives  are  reg- 
istered in  Wappinger.  One  playground,  supported  by  the  Dutchess 
Bleachery,  is  open  to  children  of  pre-school  age. 

Rhinebeck  village  has  a  district  nurse  supported  by  the  Church 
of  the  Messiah  and  a  child  welfare  station  is  maintained  which  had 
an  attendance  of  108  children  last  year.  Both  physicians  and 
nurse  are  present  and  follow  up  work  is  carried  on  by  the  nurse. 
The  Thompson  Home  Hospital  cared  for  nine  obstetrical  cases 
last  year.  This  organization  attempted  to  carry  on  some  prenatal 
work  a  few  years  ago,  but  discontinued  it  because  of  lack  of  funds. 
The  Little  Mothers'  Leagues  had  to  be  given  up  also,  though  they 
had  been  very  successful. 

ERIE  COUNTY 

Contains  42  Civil  Divisions  (two  cities,  25  townships,  and 
15  incorporated  villages),  and  has  a  total  population  of  598,549. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  93,  in 
Buffalo  93,  and  in  Lackawanna  76.  In  13  out  of  42  Civil  Divisions 
some  form  of  organized  work  is  carried  on  along  the  lines  of 
maternity  and  infant  hygiene.  Only  two  counties,  Dutchess  and 
Westchester,  surpass  Erie  in  the  proportion  of  their  territory 
covered. 

In  Buffalo  supervision  is  given  to  expectant  mothers  through 
clinics  and  health  centers  with  physicians  and  nurses  in  attend- 
ance. The  Department  of  Health  and  the  District  Nursing  Asso- 
ciation are  engaged  in  this  work.  Contacts  are  made  through 
home  visits  and  by  literature  systematically  sent  out  by  the  De- 
partment of  Health  to  all  young  married  women.  Eight  hospitals 
providing  236  beds  for  obstetrical  cases  cared  for  3,394  cases  last 
year  and  more  beds  are  needed.  Through  the  eight  dispensaries 
234  women  came  for  aid  and  31  were  attended  in  their  own  homes. 
Nursing  care  during  confinement  is  provided  through  the  District 
Nursing  Association  and  the  City  Department  of  Hospitals  and 
Dispensaries.  Seventy-seven  midwives  are  registered  in  Buffalo 
and  four  were  prosecuted  last  year  for  practicing  illegally.  Six- 
teen nurses  give  full  time  to  infant  work  and  20  child  welfare 

93 


stations  had  an  attendance  of  17,667  children  under  three  years 
of  age.  These  welfare  stations  are  maintained  through  the 
cooperation  of  the  Department  of  Health,  the  Department  of 
Hospitals  and  Dispensaries  and  the  District  Nursing  Association, 
and  are  supported  in  part  by  public  and  in  part  by  private  funds. 
Milk  is  sent  free  to  homes  upon  recommendation  of  the  clinic 
nurses.  Educational  work  is  carried  on  through  Little  Mothers' 
Leagues,  health  consultations,  exhibits,  newspaper  articles,  etc. 
The  school  nurses  have  charge  of  the  nutritional  work  and  instruct 
mothers  in  regard  to  proper  diets  for  children.  Six  day  nurseries 
(five  private  and  one  public)  had  about  48,000  admissions  last 
year  of  children  under  15  years  of  age.  Sixteen  public  play- 
grounds are  open  to  children  of  pre-school  age. 

In  Lackawanna  some  supervision  is  given  to  expectant  mothers 
through  home  visiting  by  the  nurse  employed  by  the  Board  of 
Health.  One  hospital  has  50  beds  for  obstetrical  cases  and  has 
a  very  active  service,  many  patients  coming  from  out  of  town. 
It  has  no  outside  delivery  service,  but  nursing  care  is  provided 
through  the  public  health  nurse.  The  Community  House  also 
employs  a  full-time  nurse  for  infant  work  and  two  infant  welfare 
clinics  are  held,  each  with  a  physician  and  nurse  in  attendance. 
An  attempt  is  made  to  see  that  physical  defects  are  corrected, 
but  the  clinical  facilities  are  insufficient.  The  Community  House 
is  doing  educational  work  and  it  maintains  a  playground  which 
is  open  to  children  of  pre-school  age. 

Lancaster  village  has  a  public  health  nursing  service  and  a 
clinic  is  held  through  which  supervision  is  given  to  expectant 
mothers,  in  addition  to  home  visiting.  Last  year  fifty  women  were 
reached.  Nursing  care  during  confinement  is  provided  for  women 
in  their  own  homes.  One  nurse  gives  full  time  to  infant  work  and 
to  children  of  pre-school  age.  A  child  welfare  station  with  a  physi- 
cian also  in  attendance  cared  for  250  children  last  year. 

Four  townships,  Amherst,  Aurora,  Newstead  and  Tonawanda, 
have  public  health  nurses  who  give  part  of  their  time  to  infant 
work  and  to  health  supervision  of  expectant  mothers.  A  baby 
welfare  clinic  is  held  every  two  weeks  for  the  infants  of  Amherst 
township  and  cared  for  45  last  year.  The  physician's  services  are 
volunteered.  Thirty-one  expectant  mothers  were  given  supervi- 
sion through  home  visits  made  by  the  nurse.  There  is  also  a 
child  welfare  station  in  Kenmore  which  had  an  attendance  of  25 

94 


babies  a  week.  In  Aurora  the  Red  Cross  and  Metropolitan  Life 
Insurance  Company  contribute  jointly  towards  the  expense  of  the 
nurse.  In  Newstead  the  expense  is  met  by  public  funds.  In 
Orchard  Park  three  baby  clinics  were  held  by  the  Red  Cross  with 
the  local  physicians  giving  their  services  and  a  nurse  from  the 
Buffalo  chapter  whose  expenses  were  met  by  the  local  branch. 
Some  educational  work  is  done  through  Red  Cross  home  nursing 
classes. 

ESSEX  COUNTY 

Contains  27  Civil  Divisions  (18  townships  and  nine  incor- 
porated villages) ,  and  has  a  total  population  of  35,466.  Its  infant 
mortality  rate  for  1921  was  80. 

There  is  no  organized  supervision  for  expectant  mothers  in 
the  county.  In  Keene  Valley  the  Community  Home  employs  a 
nurse  who  does  general  public  health  work  and  runs  a  clinic. 
Elizabethtown  had  a  public  health  nurse  for  three  months.  Lake 
Placid  and  Mineville  have  school  nurses,  and  Ticonderoga  for- 
merly had  a  village  nurse,  but  in  none  of  these  places  is  any  special 
work  being  done  for  infants  and  children  of  pre-school  age. 

There  are  two  hospitals  in  the  county,  but  neither  of  them 
take  obstetrical  cases,  nor  have  they  beds  for  children. 

FRANKLIN  COUNTY 

Contains  25  Civil  Divisions  (19  townships,  five  incorporated 
villages  and  one  Indian  Reservation) ,  and  has  a  total  population 
of  47,808.  Its  infant  mortality  rate  in  1921  was  110. 

There  is  practically  no  supervision  of  maternity  and  infant 
hygiene  in  the  county.  The  Board  of  Health  and  the  Metropoli- 
tan Life  Insurance  Company  are  both  doing  some  educational 
work  in  the  village  of  Malone  and  insurance  collectors  persuade 
expectant  mothers  to  take  advantage  of  this  instruction.  There 
are  no  public  health  nurses  for  infant  work.  There  is  a  village 
nurse  in  Malone  and  a  school  nurse  at  Saranac  Lake,  but  they  are 
occupied  with  other  duties.  One  hospital  in  Malone  and  one  in 
Saranac  Lake  take  obstetrical  cases.  Twelve  beds  are  provided. 

FULTON  COUNTY 

Contains  15  Civil  Divisions  (two  cities,  10  townships  and 
three  incorporated  villages) ,  and  has  a  total  population  of  45,769. 

95 


Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  87,  in 
Gloversville  62  and  in  Johnstown  65. 

There  is  practically  no  organized  supervision  for  maternity 
and  infant  hygiene  excepting  in  the  two  cities  of  Johnstown  and 
Gloversville,  where  clinics  are  held  and  home  visits  made.  In 
Johnstown  this  work  is  under  the  direction  of  the  Red  Cross  and 
about  25  women  were  reached  last  year.  In  Gloversville  it  is 
under  the  direction  of  the  Mothers'  League. 

The  one  hospital  in  the  county,  located  in  Gloversville,  takes 
obstetrical  cases  but  more  beds  are  needed,  as  there  are  only  five 
at  present  available  for  these  cases. 

The  Red  Cross  nurse  in  the  city  of  Johnstown  is  employed 
full  time  for  children  of  pre-school  age,  and  640  children  under 
five  years  of  age  attended  the  child  welfare  station  last  year. 
In  Gloversville  the  nurse  in  charge  of  this  work  is  employed  by 
the  Mothers'  League  and  about  800  children  attended  their  child 
welfare  station.  The  day  nursery  in  Gloversville  has  an  attend- 
ance of  about  6,000  children  annually.  There  is  also  a  Little 
Mothers'  League  in  this  city. 

The  county  nurse  employed  by  the  County'  Tuberculosis  Asso- 
ciation distributes  some  educational  literature,  but  her  time  is 
entirely  taken  up  with  the  school  work  and  other  duties. 

GENESSEE  COUNTY 

Contains  20  Civil  Divisions  (one  city,  13  townships  and  six 
incorporated  villages) ,  and  has  a  total  population  of  39,843.  Its 
mortality  rate  for  infants  in  1921  was  100,  and  in  Batavia  111. 

About  one-third  of  the  inhabitants  of  the  county  live  in  Bata- 
via and  one-eighth  in  LeRoy,  the  rest  in  eleven  small  villages, 
six  of  which  are  incorporated.  The  only  organized  work  for 
maternity  and  infant  hygiene  is  found  in  the  city  of  Batavia  and 
in  the  village  of  LeRoy. 

Care  is  given  to  expectant  mothers  in  Batavia  through  a  clinic 
which  was  attended  by  52  women  last  year.  Two  hospitals  in 
Batavia  provide  11  beds  for  obstetrical  cases  and  157  women  were 
cared  for  during  the  last  year.  A  full-time  nurse  is  employed  by 
the  Infant  Welfare  Association  and  about  9  per  cent,  of  the  chil- 
dren under  two  years  of  age  are  reached.  There  was  an  attendance 
of  250  children  at  the  child  welfare  station  during  the  past  year. 

96 


Methods    of   baby    care    are    popularized   through    child    welfare 
exhibits  and  distributing  pamphlets. 

In  LeRoy  health  supervision  to  expectant  mothers  is  given 
through  home  visiting  by  the  Red  Cross  nurse.  The  child  welfare 
station  admits  infants  and  children  of  both  school  and  pre-school 
age.  Two  hundred  children  were  in  attendance  last  year.  No 
special  educational  work  is  being  done  in  prenatal  care. 

GREENE  COUNTY 

Contains  19  Civil  Divisions  (14  townships  and  five  incorpo- 
rated villages),  and  has  a  total  population  of  30,191.  Its  infant 
mortality  rate  for  the  year  of  1921  was  79. 

Supervision  of  maternity  and  infant  hygiene  is  being  organized 
in  the  village  of  Catskill  by  the  Red  Cross  nurse.  Thirteen  ex- 
pectant mothers  have  been  reached  and  49  children  under  two 
years  of  age  have  attended  the  child  welfare  station  during  the 
past  year.  In  the  towns  of  Tannersville  and  Hunter  the  Red 
Cross  nurse  is  also  giving  health  supervision  to  expectant  mothers. 
Ten  were  reached  in  Tannersville  and  20  in  Hunter. 

Three  school  nurses  in  these  three  villages  are  able  to  give 
some  attention  to  infants  and  children  pf  pre-school  age,  averaging 
eight  hours  a  week.  Child  health  consultations  and  child  welfare 
exhibits  have  been  held  in  Catskill. 

There  are  no  hospitals  in  the  county,  but  through  the  Red 
Cross  there  is  provision  for  nursing  care  of  women  at  confinement 
in  their  homes.  The  maternity  home  in  Catskill  cared  for  four 
cases  last  year. 

HAMILTON  COUNTY 

Contains  nine  Civil  Divisions  (nine  townships),  and  has  a 
total  population  of  4,491.  Its  infant  mortality  rate  in  1921  was  164. 
No  work  is  being  carried  on  in  the  county  which  is  primarily 
directed  towards  lessening  the  maternal  deaths  or  lowering  the 
infant  mortality  rate.  There  is  no  maternity  hospital  and  no 
health  supervision  is  given  to  expectant  mothers.  There  are  no 
public  health  nurses  in  the  county.  The  population  is  scattered 
and  the  number  of  children  is  small.  Only  55  babies  were  born 
in  1921  but  a  larger  proportion  of  its  infants  died  than  in  any 
other  county  of  the  state. 

97 


HERKIMER  COUNTY 

Contains  31  Civil  Divisions  (one  city,  19  townships  and  11 
incorporated  villages) ,  and  has  a  total  population  of  60,229.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  67,  and  in 
Little  Falls  71. 

Organized  supervision  of  maternity  and  infant  hygiene  is  con- 
fined to  Little  Falls  and  the  four  larger  villages,  Ilion,  Mohawk, 
Frankfort  and  Herkimer,  where  public  health  nurses  are  em- 
ployed. In  Frankfort  and  Herkimer  supervision  is  given  by  visiting 
nurses,  but  in  Little  Falls,  Mohawk  and  Ilion  there  are  health 
centers  or  clinics  where  prenatal  supervision  is  provided. 

Both  in  Little  Falls  and  Ilion  there  are  located  hospitals  which 
take  obstetrical  cases  but  the  hospital  in  Herkimer  takes  only  cases 
with  complications. 

Child  welfare  stations  with  physicians  and  nurses  in  attend- 
ance are  maintained  in  Little  Falls,  Mohawk  and  Ilion  and  are 
supported  in  part  by  public  funds  and  in  part  by  the  local  Red 
Cross  organizations.  In  Little  Falls  there  is  a  day  nursery  sup- 
ported by  an  industrial  plant. 

JEFFERSON  COUNTY 

Contains  42  Civil  Divisions  (one  city,  22  townships  and  19 
incorporated  villages),  and  has  a  total  population  of  88,036.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  78,  and 
in  Watertown  109. 

Educational  work  for  prenatal  and  infant  care  is  being  carried 
on  to  some  extent  in  30  of  the  42  Civil  Divisions.  In  almost  every 
case  this  is  done  through  home  nursing  classes  conducted  by  the 
Red  Cross  or  by  a  school  nurse. 

Two  hospitals  in  Watertown  provide  31  beds  for  obstetrical 
cases  and  in  the  village  of  Theresa  there  is  a  small  hospital,  sup- 
ported by  the  community,  which  takes  some  such  cases.  Neither 
has  an  outside  delivery  service. 

There  is  one  public  health  nurse  in  Watertown  giving  full  time 
to  infant  work.  A  second  nurse  gives  half  time.  These  nurses 
also  supervise  work  for  children  of  pre-school  age.  Under  the 
Health  Department  and  the  Visiting  Nurses  Association  a  child 
welfare  station  is  run.  The  attendance  last  year  was  284  chil- 
dren under  six  years  of  age,  the  majority  being  infants.  A  pre- 
98 


natal  clinic  is  also  maintained  and  supervision  was  given  to  59 
expectant  mothers. 

Carthage  and  Hounsfield  are  also  active  to  some  extent  in  work 
for  infants.  In  Carthage  a  nurse  gives  part  time  and  in  Hounsfield 
there  is  a  baby  clinic. 

The  milk  supply  in  Watertown  conforms  to  the  standard  recom- 
mended by  the  Milk  Commission.  Throughout  the  balance  of  the 
county  milk  is  sold  which  is  below  this  standard. 

LEWIS  COUNTY 

Has  26  Civil  Divisions  (18  townships  and  eight  incorporated 
villages)  and  has  a  total  population  of  25,947.  Its  infant  mortality 
rate  in  1921  was  61. 

There  is  no  prenatal  work  being  done  in  this  county  except 
in  the  town  of  Croghan,  where  a  public  health  nurse  is  employed 
by  the  Red  Cross.  This  nurse  visits  in  the  homes,  but  little  instruc- 
tion is  given  expectant  mothers,  except  by  means  of  pamphlets 
distributed  by  the  State  Department  of  Health.  There  is  no  hos- 
pital in  the  county  to  care  for  obstetrical  cases. 

There  are  only  two  public  health  nurses  in  the  entire  county. 
Their  work  is  confined  chiefly  to  inspection  in  the  schools  and 
follow  up  work  with  school  children.  Practically  nothing  is  being 
done  for  children  of  pre-school  age. 

A  little  educational  work  was  done  in  1921  through  children's 
health  consultations  in  Lowville,  Croghan,  Harrisburg,  Point 
Leyden,  Martinsburg  and  Castorland.  Over  400  children  were 
examined  and  follow-up  work  was  carried  on  by  the  public  health 
nurses. 

The  number  of  physicians  is  insufficient  to  care  for  all  rural 
calls. 

LIVINGSTON  COUNTY 

Contains  26  Civil  Divisions  (17  townships  and  nine  incor- 
porated villages) ,  and  has  a  total  population  of  38,752.  Its  mor- 
tality rate  for  infants  in  rural  districts  in  1921  was  77. 

The  nursing  associations  in  the  villages  of  Geneseo  and  Mount 
Morris '  employ  public  health  nurses  who  are  able  to  give  some 
supervision  to  expectant  mothers  through  home  visiting  and  in 
Geneseo  through  a  clinic.  Dansville  employs  a  public  health 
nurse  who  also  by  home  visiting  is  able  to  give  some  supervision 

99 


to  maternity  and  infant  hygiene.  In  the  town  of  York,  the  Retsof 
Mining  Company,  the  School  District  No.  2,  the  local  health  hoard 
and  the  Red  Cross  employ  a  nurse.  In  Mount  Morr's  about  80 
women  have  been  reached  during  the  pa  t  year,  in  Dansville  50, 
and  in  York  about  70.  The  State  Department  of  Health  and  the 
County  Tuberculosis  Association  are  both  active  in  distributing 
printed  matter  giving  simple  instructions  to  expectant  mothers. 
The  County  Tuberculosis  Association  has  adopted  an  extensive 
program  for  the  coming  year  and  special  work  in  maternity  and 
infant  hygiene  is  included. 

A  new  hospital  has  just  been  completed  in  Dansville  which  has 
five  beds  for  obstetrical  cases.  There  are  two  midwives  in  the 
county  who  are  licensed.  Sterile  supplies  can  be  obtained  at 
small  cost.  Grade  B  raw  milk  is  used  throughout  the  county. 

The  public  health  nurse  in  York  gives  most  of  her  time  to 
infant  work.  The  other  three  nurses  in  the  county  can  devote 
only  a  few  hours  a  week  to  this  special  field.  There  are  three 
child  welfare  stations  located  in  Dansville,  Geneseo  and  the  town 
of  York. 

The  educational  work  done  in  the  town  of  York  is  quite  ex- 
tensive. Four  Little  Mothers'  Leagues  have  been  graduated,  and 
there  have  been  classes  in  home  nursing  besides  child  welfare 
exhibits  and  child  health  consultations.  In  the  townships  of  West 
Sparta,  Springwater,  Sparta,  Portage  and  Ossian  Child  Consulta- 
tion Clinics  were  held  by  the  State  Department  of  Health  in  the 
month  of  May,  1920. 

MADISON  COUNTY 

Contains  26  Civil  Divisions  (one  city,  15  townships  and  10 
incorporated  villages) ,  and  has  a  total  population  of  41,742.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  82,  and  in 
the  city  of  Oneida  58. 

There  is  practically  no  work  being  done  in  the  county  for 
maternal  and  infant  hygiene.  The  Mothers'  Club  in  Earlville 
village  distributes  simple  printed  instructions.  In  Ganastota  a 
school  nurse  takes  charge  of  similar  work.  There  are  no  clinics 
throughout  the  county.  Four  hospitals  care  for  obstetrical  cases, 
three  of  which  are  located  in  Oneida.  The  fourth,  in  Canastota, 
cared  for  15  cases  last  year. 

Oneida   and  Canastota   have   school   nurses.      Oneida   has   or- 

100 


ganized  a  Little  Mothers'  League  under  the  school  nurse.  There 
is  also  a  nurse  employed  by  the  Federated  Club  who  does  bedside 
nursing.  In  Canastota  the  nurse  does  what  infant  work  she  can 
in  addition  to  her  school  duties.  One  clinic  for  children  of  pre- 
school age  was  held  in  the  spring  under  the  auspices  of  the  State 
Department  of  Health.  There  is  one  playground  in  Canastota  sup- 
ported by  private  funds  which  is  open  to  children  under  five  years 
of  age.  The  only  supervision  given  is  by  older  girls. 

Throughout  the  rest  of  the  county  nothing  is  beirfg  done  except 
a  certain  amount  of  educational  work  conducted  by  the  County 
Tuberculosis  Committee,  which  employs  two  public  health  nurses. 
The  committee  is  hoping  to  raise  sufficient  funds  for  a  nutrition 
worker. 

MONROE  COUNTY 

Contains  30  Civil  Divisions  (one  city,  19  townships  and  10 
incorporated  villages),  and  has  a  total  population  of  330,920.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  66,  and  in 
Rochester  80. 

The  city  of  Rochester  has  begun  some  excellent  work  for  ma- 
ternity and  infant  hygiene  through  its  Public  Health  Nursing 
Association.  Five  health  centers  have  been  opened  recently  for 
prenatal  work  and  for  infants  and  children  of  pre-school  age. 
These  are  supported  by  the  community  chest  and  a  physician  is 
employed  in  one  of  them.  Women  are  also  reached  in  their  homes 
through  nurses  and  social  workers.  Twenty-eight  nurses  give  full 
lime  to  work  with  infants  and  children  of  pre-school  age,  and  a 
number  of  private  organizations  as  well  as  the  Board  of  Health 
contribute  towards  their  expenses.  Eight  hospitals  provide  124 
beds  for  obstetrical  cases,  but  they  have  no  outside  delivery 
services.  Cases  were  reported  from  Rochester  last  year  in  which 
no  physician  could  be  obtained.  Provision  for  nursing  care  during 
confinement  is  made  through  the  Public  Health  Nursing  Associa- 
tion. There  is  one  maternity  home  which  is  not  licensed  nor 
supervised  by  the  health  authorities.  Midwives  are  still  practicing 
without  being  licensed  and  registered  and  none  were  prosecuted 
last  year  for  practicing  illegally.  Excellent  milk  can  be  obtained 
in  the  city,  but  not  all  is  of  this  quality.  Dip  milk  is  still  being 
sold.  Two  milk  stations  were  started  by  the  Rotary  Club  and 
taken  over  by  the  Public  Health  Nursing  Association.  Educa- 

101 


tional  work  is  being  done  through  Little  Mothers'  Leagues  and  a 
few  child  welfare  exhibits  have  been  held.  Three  nutrition  work- 
ers are  employed  by  the  Public  Health  Nursing  Association.  Two 
day  nurseries  are  supported  by  the  community  chest  and  care  for 
children  from  six  months  to  ten  years  of  age  at  a  charge  of  five 
cents  a  day. 

Outside  of  Rochester  five  townships  have  public  health  nurses, 
Brighton,  Nondequoit,  Perrington,  Sweden  and  Webster.  They 
have  many  and  varied  duties,  but  are  able  to  give  some  attention 
to  infants  and  to  expectant  mothers  through  home  visiting.  The 
Red  Cross  and  the  boards  of  health  share  the  expense.  Educa- 
tional work  has  been  carried  on  throughout  the  county  by  chil- 
dren's health  consultations,  newspaper  article",  pamphlets  dis- 
tributed and  lectures  with  moving  pictures  and  slides.  The  Tuber- 
culosis Association  has  been  the  most  active  county  organization 
in  this  field  and  it  employs  a  nutrition  worker.  Little  Mothers' 
Leagues  have  been  formed  in  Wheatland,  Pairua,  Brighton,  Non- 
dequoit, Sweden,  Webster,  and  in  the  villages  of  East  Rochester 
and  Fairport. 

MONTGOMERY  COUNTY 

Contains  20  civil  divisions  (one  city,  ten  townships  and 
nine  incorporated  villages) ,  and  has  a  total  population  of  64,924. 
Its  infant  mortality  rate  in  rural  districts  in  1921  was  62,  and  in 
Amsterdam  87. 

Amsterdam  has  two  hospitals  with  20  beds  for  obstetrical  cases. 
There  are  five  mid  wives  registered.  A  certain  amount  of  care  is 
given  expectant  mothers  in  the  home  and  printed  matt  r  is  dis- 
tributed by  the  Department  of  Health,  which  also  employs  a 
part-time  nurse  for  infant  work  and  work  with  children  of  pre- 
school age.  A  second  nurse  is  employed  for  this  work  by  the 
Metropolitan  Life  Insurance  Company.  One  clinic  for  children 
is  held  under  the  supervision  of  the  Health  Department.  A  physi- 
cian and  two  nurses  attend,  and  the  nurses  carry  on  the  follow-up 
work.  Educational  work  is  also  done  by  the  Health  Department 
by  means  of  child  welfare  exhibits  and  pamphlets  and  local  papers. 
There  is  one  day  nursery  caring  for  children  under  five  years  of 
age.  Milk  here  is  up  to  the  standard  of  the  State  Commission, 
though  this  is  not  true  in  some  of  the  rural  districts. 

Outside  of  Amsterdam  there  is  no  ma'ernal  or  infant  hygiene 

102 


work  in  the  county,  except  that  of  one  county  tuberculosis  nurse 
from  the  Amsterdam  Sanitorium,  and  three  school  nurses.  The 
work  of  the  tuberculosis  nurse  is  confined  to  tuberculous  patients, 
and  care  is  given  both  in  clinics  and  in  the  homes.  Printed  mat- 
ter is  distributed  by  health  officers  and  public  health  classes  are 
held. 

There  are  no  infant  nurses  and  no  child  welfare  stations 
throughout  the  rest  of  the  county,  but  a  Public  Health  League 
supported  by  the  Women's  Club  is  doing  educational  work 
through  local  newspapers  and  by  means  of  lectures. 

NASSAU  COUNTY 

Contains  23  Civil  Divisions  (one  city,  three  townships  and 
19  incorporated  villages),  and  has  a  total  population  of  104,720. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  70, 
and  in  Glen  Cove  53. 

Some  excellent  work  is  being  carried  on  along  the  lines  of 
maternity  and  infant  hygiene  in  a  number  of  townships.  Health 
centers  have  been  established  in  Glen  Cove,  Lawrence,  Roslyn 
Heights,  Great  Neck,  Saddle  Rock,  Port  Washington,  Kensington, 
Westbury  and  Locust  Valley,  where  advice  is  given  to  expectant 
mothers  and  clinics  are  held  for  infants  and  children  of  pre-school 
age.  Five  hospitals  take  obstetrical  cases,  two  in  Hempstead,  one 
in  Roslyn  Heights,  one  in  Far  Rockaway  and  the  county  hospital 
in  Mineola.  At  least  21  midwives  are  registered  in  the  county. 
Three  were  prosecuted  in  Glen  Cove  the  year  before  last  for  prac- 
ticing illegally. 

A  public  health  nurse  is  employed  in  Glen  Cove  and  in  each 
of  the  following  villages  by  a  local  visiting  nurses'  association  or 
health  league  which  raises  its  funds  for  the  most  part  through 
private  subscriptions:  Oyster  Bay,  Port  Washington,  Lawrence, 
Roslyn  Heights,  Westbury,  Great  Neck,  Manhasset  and  Locust 
Valley.  These  nurses  do  all  forms  of  public  health  nursing,  in- 
cluding bedside  care,  but  they  devote  part  of  their  time  to  infant 
work.  They  are  in  attendance  at  the  child  welfare  stations  during 
the  hours  when  they  are  open,  and  they  give  some  supervision 
to  children  and  expectant  mothers  also  through  home  visits.  All 
of  these  villages  have  child  welfare  stations  or  clinics,  except 
Manhasset,  which  has  held  some  baby  conferences.  The  Oyster 
Bay  station  had  an  attendance  of  447  children  last  year. 

103 


Little  Mothers'  Leagues  have  been  formed  in  Glen  Cove,  Man- 
hasset,  Sea  Cliff,  Oyster  Bay,  Lawrence,  Roslyn  Heights,  Locust 
Valley  and  Port  Washington.  In  the  latter  place  200  girls  have 
joined  such  leagues  during  the  last  four  years  and  received  in- 
struction in  personal  hygiene  and  methods  of  baby  care. 

Excellent  milk  can  be  obtained  throughout  the  county,  but 
milk  is  also  being  sold  which  is  beneath  the  standard  recom- 
mended by  the  State  Milk  Commission.  Glen  Cove  and  Oyster 
Bay  have  milk  stations  which  supply  good  milk  at  low  cost,  or 
free,  for  children  needing  it. 

A  day  nursery  in  Great  Neck  cares  for  25  children  annually 
and  one  playground  there  and  two  in  Glen  Cove  are  open  to  chil- 
dren of  pre-school  age.  Lawrence  and  Roslyn  Heights  also  have 
playgrounds  for  small  children  with  supervision  by  trained  work- 
ers, supported  by  private  funds.  The  one  in  Roslyn  Heights, 
which  is  supported  by  the  community  center,  would  welcome  vol- 
unteer assistants.  Such  assistance  could  also  be  used  at  Glen  Cove. 
The  Home  Bureau  and  the  Red  Cross  have  given  classes  in 
dietetics  in  several  villages. 

NIAGARA  COUNTY 

Contains  21  Civil  Divisions  (three  cities,  12  townships  and 
six  incorporated  villages),  and  has  a  total  population  of  104,500. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  76,  in 
Niagara  Falls  95,  in  Lockport  93,  and  in  North  Tonawanda  90. 

The  only  organized  supervision  for  maternity  hygiene  in  the 
county  is  carried  on  in  Niagara  Falls.  A  prenatal  clinic  is  held 
and  expectant  mothers  are  also  visited  in  their  homes. 

Two  hospitals  in  Niagara  Falls  take  obstetrical  cases.  About 
268  cases  were  cared  for  during  the  past  year.  There  are  seven 
midwives  registered  in  Niagara  Falls  and  three  in  North  Tona- 
wanda. 

Three  public  health  nurses  in  Niagara  Falls  give  full  time  to 
infant  work,  and  one  in  North  Tonawanda.  There  are  four  child 
welfare  stations  located  in  Niagara  Falls  with  2,545  infants  from 
birth  to  two  years  of  age  in  attendance  last  year.  There  are  two 
child  welfare  stations  located  in  North  Tonawanda,  with  an 
attendance  of  500  children.  The  Child  Welfare  Committee  carries 
on  the  follow  up  work. 

Educational  work  in  child  welfare  is  being  carried  on  in  the 

104 


towns    of    Lewiston,  Wilson   and  Middleport  through    the    local 
health  officers. 

There  are  no  day  nurseries  in  the  county,  and  the  only  play- 
grounds open  to  children  under  five  years  of  age  are  those  of  the 
schools  in  Niagara  Falls. 

ONEIDA  COUNTY 

Contains  49  Civil  Divisions  (two  cities,  26  townships,  21 
incorporated  villages),  and  has  a  total  population  of  169,748.  Ite 
*'ural  infant  mortality  rate  in  1921  was  92.  In  the  city  of  Utica 
the  rate  was  88  and  in  the  city  of  Rome  71.  The  only  provisions 
for  prenatal,  maternal  and  infant  care  in  the  county  are  in  Utica, 
Rome,  Clinton  and  Clark  Mills. 

Clinics  for  prenatal  care  are  available  in  the  city  of  Utica. 
General  educational  supervision  is  given  by  the  child  welfare 
nurses  in  Rome,  Clark  Mills  and  Clinton  through  home  visiting 
and  through  their  child  welfare  stations.  There  are  four  hospi- 
tals in  the  city  of  Utica,  one  giving  free  service,  and  about  200 
obstetrical  cases  were  cared  for  during  the  year.  There  are  three 
hospitals  in  Rome  taking  obstetrical  cases.  Licensed  midwives  are 
located  in  both  cities;  about  30  are  registered  in  Utica  and  seven 
in  Rome. 

The  Baby  Welfare  Organization  has  four  stations  in  Utica, 
and  the  city  with  the  Junior  League  maintains  two  day  nurseries, 
with  an  average  attendance  of  80  children.  Rome  has  the  services 
of  one  child  welfare  nurse,  and  also  one  child  welfare  station. 

The  only  organized  work  in  the  rural  sections  is  at  Clinton  and 
Clark  Mills.  A  clinic  for  children  of  pre-school  age  is  held  in  each 
village  monthly. 

ONONDAGA  COUNTY 

Contains  35  Civil  Divisions  (one  city,  19  townships  and  15 
incorporated  villages) ,  and  has  a  total  population  of  223,337 
(Syracuse  171,647) .  Its  mortality  rate  for  infants  in  rural  districts 
in  1921  was  74  and  in  Syracuse  82. 

The  only  organized  supervision  of  maternity  and  infant 
hygiene  in  the  county  is  confined  to  the  city  of  Syracuse  and 
the  village  of  Jamesville.  Three  years  ago  the  Solvay  Guild 
held  clinics  in  Solvay.  It  was  stated  that  this  work  was  discon- 
tinued because  it  was  impossible  to  secure  a  -woman  physician. 

105 


About  350  expectant  mothers  were  reached  during  the  past  year 
through  the  clinics  of  Syracuse  and  24  in  Jamesville.  Eighteen 
expectant  mothers  were  reached  through  home  visiting  in  the 
town  of  Skaneateles. 

There  are  eight  hospitals  in  Syracuse  which  take  obstetrical 
cases,  and  3,060  cases  were  cared  for  during  the  past  year.  Ten 
inidwives  were  registered.  One  nurse  is  employed  in  Solvay  and 
six  in  Syracuse  for  children  of  pre-school  age.  In  Solvay  about 
500  infants  were  in  attendance  at  the  child  welfare  station.  In 
Syracuse  there  were  3,044  children  in  attendance,  largely  infants. 
In  two  of  the  child  welfare  stations  children  are  in  attendance 
up  to  six  years  of  age;  in  the  other  four  the  children  are  admitted 
from  birth  to  two  years  of  age.  There  is  a  Little  Mothers'  League 
organized  by  the  Child  Welfare  Committee.  A  day  nursery  in 
Syracuse  cares  for  about  30  children  annually  from  two  to  eight 
years  of  age  at  a  charge  of  10  cents  a  day. 

The  nutrition  workers  of  the  Home  Bureau  co-operate  in  teach- 
ing nutrition  and  instructing  mothers  in  feeding  children.  The 
Skaneateles  Woman's  Village  Improvement  Association  is  active 
in  health  education,  as  well  as  some  of  the  health  officers  in  the 
various  communities. 

ONTARIO  COUNTY 

Contains  26  Civil  Divisions  (two  cities,  16  townships  and 
eight  incorporated  villages) ,  and  has  a  total  population  of  54,242. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  68,  in 
Canandagua  99,  and  in  Geneva  91. 

No  supervision  is  given  expectant  mothers,  and  no  work  done 
along  the  lines  of  maternal  and  infant  hygiene  outside  the  cities 
of  Canandagua  and  Geneva,  where  arrangements  are  made  for 
home  visiting.  In  Canandagua  this  is  supervised  by  the  Red  Cross 
and  in  Geneva  by  the  Health  Department  and  the  Metropolitan 
Life  Insurance  Company.  In  Geneva  a  clinic  has  recently  been 
opened  by  the  Woman's  Club  and  a  public  health  nurse  has  been 
put  in  charge.  One  hospital  in  Geneva  takes  obstetrical  cases. 
No  deliveries  are  made  in  the  home,  but  eleven  beds  are  provided 
in  the  hospital  and  159  women  were  cared  for  last  year.  In  both 
cities  the  milk  supply  is  good,  meeting  all  requirements  of  the 
State  Commission. 

106 


Canandagua  has  one  public  health  nurse  supervising  all  children 
of  pre-school  age.  She  is  employed  by  the  Red  Cross,  which  or- 
ganization also  supports  a  child  welfare  station.  Follow-up  work 
is  done  by  the  nurse  and  .educational  work  carried  on  through 
children's  health  consultations,  newspapers,  distribution  of  pam- 
phlets, exhibits  and  lectures.  One  playground  in  the  city  admits 
children  under  five  years  of  age. 

The  Red  Cross  in  Geneva  first  paid  a  public  health  nurse,  who 
was  afterward  taken  over  by  the  city.  Part  of  her  time  is  devoted 
to  infants  and  young  children.  A  child  welfare  station  and  clinics 
are  held  in  the  city  under  the  County  Tuberculosis  Committee 
and  the  City  Health  Department.  Last  year  200  children  attended. 
Follow-up  work  is  done  by  the  public  health  nurse.  Recently  a 
Little  Mothers'  League  has  been  organized  and  further  educa- 
tional work  is  carried  on  by  the  Woman's  Club.  One  day  nursery 
cares  annually  for  40  children  under  12  years  of  age.  There  are 
four  playgrounds  open  to  children  under  five.  Paid  workers  and 
teachers  are  in  charge. 

There  is  one  nurse  employed  by  the  County  Board  of  Super- 
visors for  public  health  work.  Because  of  the  size  of  her  territory 
she  is  able  to  reach  only  the  sick  and  cannot  devote  her  time  to 
infant  work  and  work  with  children  of  pre-school  age.  One  play- 
ground in  East  Bloomfield  is  open  to  children  under  five.  In 
Phelps  the  school  nurse  occasionally  does  some  infant  work. 

ORANGE  COUNTY 

Contains  33  Civil  Divisions  (three  cities,  20  townships  and 
10  incorporated  villages) ,  and  has  a  total  population  of  124,863. 
Its  infant  mortality  rate  in  1921  was  82  in  rural  districts,  in  New- 
burg  77,  in  Middletown  94,  and  in  Port  Jervis  115. 

There  is  one  prenatal  clinic  in  the  county.  This  is  located 
in  the  city  of  Newburg  and  240  expectant  mothers  were  reached 
last  year  either  through  this  clinic  or  through  home  visiting.  The 
city  of  Port  Jervis  and  the  towns  of  Highlands,  Montgomery,  Corn- 
wall, Chester,  Goshen  and  Warwick  provide  some  supervision 
through  home  visiting  by  their  public  health  nurses.  Twenty 
expectant  mothers  were  visited  in  the  village  of  Goshen  during  the 
past  year. 

Seven  hospitals  in  the  county  take  obstetrical  cases,  one  in 
Newburg,  two  in  Middletown,  two  in  Port  Jervis,  one  in  Goshen 

107 


and  one  in  Warwick.  One  hundred  and  sixty-six  cases  received 
attention  in  Newburg  last  year.  Five  midwives  are  registered, 
four  in  Newburg  and  one  in  Goshen. 

There  are  public  health  nurses  giving  attention  to  the  care  of 
infants  and  children  of  pre-school  age  in  Newburg,  Port  Jervis, 
Chester,  Warwick,  Highlands,  Montgomery  and  Goshen.  New- 
burg employs  two  child  welfare  nurses  and  has  two  Child  Welfare 
Stations;  an  additional  one  is  open  during  the  summer  months. 
Children  are  admitted  up  to  school  age  and  about  600  were  in 
attendance  last  year.  There  are  also  child  welfare  stations  in 
Port  Jervis  and  Warwick.  Day  nurseries  are  organized  in  New- 
burg and  Middletown  with  an  attendance  of  3,000  and  4,000  chil- 
dren, respectively. 

Education  in  baby  care  is  being  promoted  in  Newburg,  Port 
Jervis,  Highlands,  Tuxedo,  Warwick,  Walden  and  Goshen  through 
the  Red  Cross,  the  visiting  nurses,  the  Anti-Tuberculosis  Nurse, 
and  the  Metropolitan  Life  Insurance  Company.  In  Newburg  the 
Associated  Charities  employs  a  nutrition  worker  who  makes  visits 
and  teaches  methods  of  feeding  children.  The  school  nurse  also 
gives  instructions  regarding  the  value  and  preparation  of  food. 

ORLEANS  COUNTY 

Contains  14  civil  divisions  (ten  townships,  four  incorporated 
villages) ,  and  has  a  total  population  of  33,341.  Its  infant  mor- 
tality rate  in  1921  was  74. 

No  prenatal  work  has  been  attempted  in  the  county  except  in 
Medina  Village,  where  instructions  are  given  in  the  homes  by  a 
nurse  employed  by  the  Public  Health  Committee  in  Medina,  and 
two  adjacent  townships.  In  Albion  there  is  a  hospital  which 
takes  obstetrical  cases  but  no  provision  is  made  for  outside 
deliveries. 

The  community  nurse  in  Medina  has  also  been  active  in  child 
welfare  work.  The  village  is  too  small  to  support  a  permanent 
clinic. 

There  is  one  dietitian  employed  by  the  Home  Bureau  who  has 
covered  the  towns  of  Albion,  Caines,  Carlton,  Yates,  Clarendon, 
Murray,  Barre  and  Kendall.  Some  educational  work  is  done  by 
the  County  Tuberculosis  Nurse. 

OSWEGO  COUNTY 

Contains  34  civil   divisions    (two  cities,  22   townships  and 

108 


10  incorporated  villages),  and  has  a  total  population  of  72,235. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  78, 
in  Fulton  71,  and  in  Oswego  103. 

Prenatal  work  is  carried  on  in  both  Oswego  and  Fulton  cities 
and  337  expectant  mothers  were  reached  in  Oswego  through  the 
health  center  and  home  visiting  by  the  public  health  nurse. 

There  is  a  hospital  in  each  city  which  takes  obstetrical  cases, 
but  the  total  number  of  beds  available  is  only  six.  Two  midwives 
are  registered  in  Oswego. 

A  child  welfare  nurse  in  Fulton  gives  entire  time  to  infant 
work.  The  public  health  nurse  in  Oswego  also  cares  for  children 
of  pre-school  age.  The  child  welfare  station  in  Fulton  only 
admits  infants,  that  is,  children  up  to  two  years  of  age.  The 
station  in  Oswego  admits  children  up  to  six  years  of  age,  although 
the  attendance  is  largely  composed  of  infants.  The  total  number 
during  the  last  year  was  794. 

There  are  Little  Mothers'  Leagues  in  both  cities.  Educational 
work  is  done  by  the  child  welfare  nurse  through  distribution  of 
pamphlets  and  exhibits  in  the  city  of  Fulton. 

There  are  no  nutrition  workers  in  the  county  and  no  day 
nurseries. 

OTSEGO  COUNTY 

Contains  35  civil  divisions  (one  city,  24  townships  and  10 
incorporated  villages) ,  and  has  a  total  population  of  48,534.  Its 
infant  mortality  rate  for  1921  was  71  in  rural  districts,  and  72 
for  the  city  of  Oneonta. 

There  is  no  organized  supervision  of  maternity  hygiene  in  the 
county.  Two  hospitals  provide  two  beds  for  obstetrical  cases,  one 
in  Oneonta  and  one  in  Cooperstown. 

The  Red  Cross  public  health  nurse  in  Oneonta  is  able  to  give 
some  attention  to  infant  work  and  to  that  of  pre-school  children. 
She  gets  in  touch  with  newly  born  infants  through  her  work  of 
delivering  birth  certificates.  There  is  a  child  welfare  station 
with  a  doctor  and  nurse  in  charge  and  220  children  from  one  to 
seven  years  of  age  were  in  attendance  during  the  last  year.  A 
Little  Mothers'  League  is  organized  in  the  village  of  Morris. 

The  executive  of  the  County  Tuberculosis  Committee  has  been 
active  in  educational  work. 

109 


PUTNAM  COUNTY 

Contains  nine  civil  divisions  (six  townships,  three  incor- 
porated villages),  and  has  a  total  population  of  15,307.  Its  infant 
mortality  rate  for  the  year  of  1921  was  78. 

There  is  no  organized  supervision  of  maternity  hygiene  in  the 
county.  The  doctors  and  nurses  cooperate  in  sending  out  the 
pamphlets  provided  by  the  State  Department  of  Health.  The  Red 
Cross  and  State  Charities  Aid  employ  an  agent  for  dependent 
children  who  is  doing  educational  work  in  this  other  field,  also  a 
District  Nursing  Association  is  being  formed  in  the  town  of  Carmel 
and  supervision  in  maternity  and  infant  hygiene  will  be  inaugu- 
rated within  the  next  six  months.  A  hospital  is  being  opened  in 
Cold  Spring  and  there  will  be  a  clinic  in  connection  with  it. 

RENSSELAER  COUNTY 

Contains  21  civil  divisions  (two  cities,  14  townships,  five 
incorporated  villages) ,  and  has  a  total  population  of  122,698.  Its 
rural  infant  mortality  rate  in  1921  was  71,  93  in  Troy  and  103  in 
Rensselaer. 

Practically  no  work  is  being  done  in  this  county  for  maternal 
and  infant  hygiene  except  in  Troy,  where  supervision  is  given 
expectant  mothers  in  clinics  and  in  the  homes  by  the  Health 
Department  and  Maternity  Center.  Here  also  are  four  hospitals 
which  provide  42  beds  for  obstetrical  cases.  Seven  midwives  are 
registered  and  licensed.  There  are  two  full  time  public  health 
nurses,  employed  by  the  Department  of  Health,  who  care  for 
infants  and  children  of  pre-school  age.  This  department  in  co- 
operation with  the  Babies'  Milk  Station,  Day  Home  and  the 
County  Tuberculosis  Association,  conducts  four  child  welfare  sta- 
tions for  children  of  all  ages.  Four  nurses  and  a  physician  are 
employed  and  follow  up  work  is  done  by  the  former.  Little 
Mothers'  Leagues,  child  welfare  exhibits,  children's  health  con- 
sultations and  printed  matter  are  used  to  promote  educational 
health  work.  Two  dietitions  are  employed  by  the  City  Health 
Department,  and  there  are  two  day  nurseries  caring  for  children 
from  infancy  to  twelve  years  of  age.  One  hundred  and  ninety-six 
children  are  taken  care  of  annually,  and  small  charges  are  made 
where  the  parents  can  afford  it.  Eight  playgrounds  admit  children 
under  five  years  of  age,  but  these  are  not  sufficient  to  meet  the 

110 


needs  of  the  city.     Milk  of  all  grades  is  used,  some  being  below 
the  standard  set  by  the  State  Commission. 

Clinics  have  been  held  occasionally  under  the  Tuberculosis 
Committee  in  most  townships,  one  nurse  and  a  secretary  are  em- 
ployed by  this  committee  and  they  give  some  time  to  infant  work. 

ROCKLAND  COUNTY 

Contains  15  civil  divisions  (five  townships  and  ten  incor- 
porated villages),  and  has  a  total  population  of  53,130.  Its  mor- 
tality rate  for  infants  in  1921  was  54. 

Provision  for  care  of  expectant  mothers  is  made  in  many  of 
the  towns  and  villages  of  this  county  and  a  prenatal  clinic  is  held 
in  Upper  Nyack.  Twenty-five  expectant  mothers  were  reached  in 
Ramapo  township,  and  home  visiting  is  also  done  by  the  nurses  in 
the  villages  of  Nyack,  Upper  Nyack,  South  Nyack,  and  Grand- 
View-on-Hudson.  No  organized  supervision  is  being  given  to 
expectant  mothers  in  the  villages  of  Haverstraw,  Stony  Point  and 
Orange. 

The  county  hospital  in  Suffern  cared  for  81  obstetrical  cases 
during  the  past  year.  Six  midwives  are  registered.  None  have 
been  prosecuted  so  far,  but  one  is  reported  as  undesirable. 

The  township  of  Ramapo  includes  three  incorporated  villages 
and  in  this  district  there  are  three  public  health  nurses  giving 
much  time  to  infant  work  and  children  of  pre-school  age.  In  the 
township  of  Clarkestown,  Haverstraw,  and  Grand- View-on-Hudsou 
village  the  nurse  gives  some  attention  to  this  field  of  work.  Baby 
clinics  are  held  during  two  months  of  the  summer  in  the  villages 
of  Suffern,  Hillburn  and  Ramapo.  Child  welfare  stations  which 
are  located  in  Upper  Nyack,  South  Nyack,  Nyack  and  Grand- 
View-on-Hudson  admit  children  up  to  six  years  of  age.  In  Spring 
Valley  the  school  nurse  in  cooperation  with  the  Parent  Teachers 
Association  has  been  carrying  on  nutrition  work  among  the  chil- 
dren of  kindergarten  age. 

ST.  LAWRENCE  COUNTY 

Contains  46  civil  divisions  (one  city,  32  towns  and  13  incor- 
porated villages),  and  has  a  total  population  of  90,291.  Its  infant 
mortality  rate  for  rural  sections  was  86  and  for  the  city  of  Ogdens- 
burg  150. 

There  is  no  organized  prenatal  work  in  the  county.    Occasional 
supervision  is  given  to  women  in  the  towns  of  Gouverneur,  Mas- 
Ill 


scna,  Potsdam  and  in  Gouveriieur  village.  In  Ogdensburg  the 
Metropolitan  Life  Insurance  Company  does  some  work  which  is 
limited  to  policy  holders.  Occasional  clinics  are  held  in  the  vil- 
lage of  Gouverneur.  An  effort  by  the  State  Department  of  Health 
to  inaugurate  prenatal  work  in  Ogdensburg  failed  because  of  lack 
of  public  support.  One  hospital  in  Ogdensburg  takes  obstetrical 
cases.  Maternity  homes  are  found  in  Ogdensburg,  Gouverneur, 
Massena  and  Potsdam.  Midwives  are  also  registered  in  each  of 
these  places. 

Public  health  nurses  are  employed  by  the  boards  of  health  in 
Gouverneur,  Massena,  and  Potsdam  and  by  the  Metropolitan  Life 
Insurance  Company  in  Ogdensburg.  There  is  one  child  welfare 
station  in  Massena  which  takes  children  up  to  six  years  of  age. 
This  is  under  the  supervision  of  the  public  health  nurse  and  is 
adequately  equipped. 

In  Ogdensburg,  Potsdam  and  Massena  some  milk  below  stand- 
ard is  sold  while  that  of  Gouverneur  conforms  to  the  standards 
of  the  State  Milk  Commission. 

SARATOGA  COUNTY 

Contains  29  civil  divisions  (two  cities,  19  townships  and 
eight  incorporated  villages),  and  has  a  total  population  of  62,521. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  92,  in 
Saratoga  Springs  55,  and  Mechanicville  69. 

There  is  only  .one  place  in  this  county  where  supervision  is 
given  to  expectant  mothers,  and  that  is  the  city  of  Saratoga 
Springs.  No  prenatal  clinics  are  held  but  the  city  nurse  visits 
women  in  their  homes.  The  Home  Bureau  in  cooperation  with 
the  State  Department  of  Health  has  conducted  health  lectures  in 
the  county  with  special  attention  to  prenatal  care.  Their  total 
attendance  was  1,240  during  1921,  and  19  communities  wer« 
reached. 

One  hospital  in  Saratoga  Springs  cares  for  obstetrical  cases. 
There  are  six  midwives  registered  in  Mechanicville,  four  in  Sara- 
toga Springs,  and  one  in  South  Glens  Falls.  There  is  one  milk 
station  in  South  Glens  Falls. 

Mechanicville  and  Saratoga  Springs  each  employs  a  full  time 
public  health  nurse,  but  no  attention  is  given  to  infants  and  pre- 
school children.  In  Ballston  Spa  village  there  is  a  part  time  public 
health  nurse  supported  by  the  Red  Cross  and  public  schools.  Only 

112 


incidental  attention  can  be  given  to  small  children.  There  is  no 
county  public  health  nurse.  The  Metropolitan  Life  Insurance 
Company  maintains  a  nurse  who  does  some  work  jn  rural  sections, 
but  her  attention  is  given  mainly  to  tuberculosis  work.  The  com- 
pany conducts  a  health  exhibit  tent  at  the  county  fair  and  ran  a 
day  nursery  in  connection  with  it  this  year,  giving  information  to 
mothers  about  the  care  of  children. 

There  are  no  child  welfare  stations,  clinics  or  health  centers 
in  the  county.  Milk  which  is  below  the  standard  recommended  by 
the  State  Commission  is  sold  throughout  the  county. 

SCHENECTADY  COUNTY 

Contains  seven  civil  divisions  (one  city,  five  townships  and 
one  incorporated  village),  and  has  a  total  population  of  118,441. 
Its  rural  infant  mortality  rate  in  1921  was  67,  and  in  the  city  of 
Schenectady  64. 

The  city  of  Schenectady  and  the  town  of  Rotterdam  are  giving 
instructions  and  supervision  to  expectant  mothers  in  clinics  and  in 
the  homes.  The  Health  Department  of  Schenectady  supplies  the 
nurses  for  that  city  and  221  women  were  reached  last  year.  In 
Rotterdam  this  work  is  under  the  direction  of  the  Public  Health 
Nursing  Association  and  further  educational  work  is  done  by  the 
Metropolitan  Life  Insurance  Company  and  the  Health  Depart- 
ment. 

The  Rotterdam  hospital  which  accommodates  fifteen  maternity 
cases  cared  for  230  women  last  year,  and  there  are  two  maternity 
homes.  Nursing  care  at  confinement  is  provided  in  the  homes  by 
the  Public  Health  Nursing  Association.  Twenty  midwives  are 
registered  and  licensed  by  the  commissioner  of  health.  One  was 
prosecuted  for  practicing  illegally  last  year.  There  is  also  a  hos- 
pital in  Schenectady  which  takes  obstetrical  cases.  There  are 
twenty-five  beds  for  such  cases.  The  city  has  three  maternity 
homes. 

Schenectady  has  five  full  time  nurses  and  four  additional  nurses 
during  the  summer  months  under  the  Visiting  Nurses  Association 
and  life  insurance  companies  to  care  for  infants  and  children  of 
pre-school  age.  Twenty-three  hundred  and  seventy-eight  children 
— the  majority  being  infants — were  cared  for  last  year  in  the  four 
child  welfare  stations  which  are  under  the  Health  Department 
and  supervised  by  physicians  and  nurses.  One  full  time  nurse 

113 


under  the  Public  Health  Nursing  Association  in  Rotterdam  has 
charge  of  infant  work  and  work  with  children  of  pre-school  age. 
The  Public  Health  Nursing  Association  also  conducts  a  child 
welfare  station  where  children  of  all  ages  are  admitted.  Educa- 
tional work  is  being  done,  too,  through  Little  Mothers'  Leagues, 
children's  health  consultations,  exhibits  and  lectures  in  both  cities. 

In  Rotterdam,  nutrition  classes  are  held  by  the  Red  Cross 
and  this  work  is  being  organized  in  Schenectady.  In  the  latter, 
27  day  nurseries  cared  for  5,162  children  from  three  months  to 
eight  years  of  age  last  year.  Nominal  sums  are  charged  by  the  nur- 
series for  the  care  given  if  the  parent  or  parents  are  working. 

A  public  health  nurse  was  provided  up  to  September  1st  by 
the  Red  Cross  for  Glenville  and  Scotia  and  in  other  districts 
maternal  and  infant  hygiene  work  is  under  consideration. 

Ten  playgrounds  in  Schenectady  admit  children  under  school 
age  and  their  play  is  supervised  by  a  nurse  and  her  assistants. 

SCHOHARIE  COUNTY 

Contains  22  civil  divisions  (16  townships  and  six  incor- 
porated villages),  and  has  a  total  population  of  23,005.  Its  mor- 
tality rate  for  infants  in  1921  was  58. 

In  Schoharie  the  Red  Cross  Home  Service  does  a  certain 
amount  of  visiting  in  the  homes  and  pamphlets  are  sent  out 
through  the  Free  Library,  but  aside  from  this  practically  no 
attempt  has  been  made  to  inaugurate  work  along  the  lines  of 
maternal  and  infant  hygiene  and  there  is  no  maternity  home  or 
hospital  taking  obstetrical  cases  in  the  county.  In  the  towns  of 
Cobbleskill  and  Esperance  there  is  an  insufficient  number  of 
physicians  for  rural  cases.  Literature  provided  by  the  State 
Department  of  Health  is  distributed  to  expectant  mothers  and 
supervision  is  occasionally  given  by  the  local  health  officers. 

The  Red  Cross  employs  one  public  health  nurse  for  the  County 
who  supervises  infant  work  and  work  with  children  of  pre-school 
age  and  the  Metropolitan  Life  Insurance  Company  has  a  worker 
in  Cobbleskill. 

Child  welfare  stations  are  maintained  in  Schoharie  and  Cob- 
bleskill. In  the  latter  town  about  40  children  attended  last 
year.  Further  instruction  was  given  in  these  places  by  the  Health 
Department  and  the  Red  Cross.  In  Jefferson  reading  courses  are 

114 


conducted  under  the  auspices  of  Cornell  University  and  instruc- 
tion is  given  in  this  way  in  dietetics. 

SCHUYLER  COUNTY 

Contains  12  civil  divisions  (eight  townships  and  four  incor- 
porated villages) ,  and  has  a  total  population  of  13,957.  Its  infant 
mortality  rate  in  1921  was  41. 

There  is  no  activity  along  the  lines  of  maternal  and  infant 
hygiene  throughout  the  county.  At  one  time  an  attempt  was 
made  by  the  Red  Cross  to  inaugurate  this  work  in  Montour  Falls, 
Watkins,  and  the  rural  sections  but  the  nurse  was  withdrawn 
after  a  few  months.  One  hospital  in  the  county  providing  eight 
beds  for  obstetrical  cases  has  recently  been  opened.  It  makes  no 
provision  for  outside  deliveries. 

In  both  Montour  Falls  and  Watkins  milk  is  sold  which  is  below 
the  standard  of  quality  recommended  by  the  State  Commission. 

Some  educational  work  is  done  by  the  board  of  health  in 
Watkins  and  Montour  Falls  and  through  the  Camp  Fire  Girls  in 
Watkins. 

SENECA  COUNTY 

Contains  14  civil  divisions  (10  townships  and  four  incor- 
porated villages) ,  and  has  a  total  population  of  25,249.  Its  infant 
mortality  rate  in  1921  was  91. 

No  educational  work  is  being  done  along  the  line  of  maternal 
and  infant  hygiene  in  the  county  and  no  clinics  are  held.  Hos- 
pitals in  Waterloo  and  Seneca  Falls  provide  twelve  beds  for 
obstetrical  cases,  but  the  service  is  not  free  and  there  is  no  pro- 
vision for  outside  deliveries  in  either  place. 

There  are  no  nurses  in  Seneca  County  for  infant  work  and 
work  with  children  of  pre-school  age,  but  one  public  health  nurse 
is  employed  by  the  Tuberculosis  Committee  and  in  Waterloo  yearly 
clinics  are  held.  Clinics  are  also  held  in  Ovid,  where  six  children 
attended  last  year.  Funds  for  this  work  are  raised  by  the  sale  of 
Red  Cross  Seals. 

Waterloo  supports  a  day  nursery  during  the  canning  season 
for  children  up  to  ten  years.  About  twelve  were  cared  for  last 
year  and  a  nominal  charge  made  to  the  parents. 

STEUBEN  COUNTY 

Contains  46  civil  divisions  (two  cities,  32  townships  and  12 

115 


incorporated  villages ) ,  and  has  a  total  population  of  83,755 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  63,  in 
Corning  56,  and  in  Hornell  89. 

The  only  organized  activities  in  maternal  and  infant  hygiene 
are  in  Hornell  and  Corning.  Health  supervision  is  given  in  Corn- 
ing through  home  visiting,  and  in  Hornell  both  through  home 
visiting  and  a  clinic.  Twenty  expectant  mothers  were  reached 
in  the  city  of  Hornell  during  the  past  year.  In  six  townships 
there  is  no  resident  physician. 

There  are  two  hospitals  in  Hornell  which  take  obstetrical  cases 
and  320  cases  were  cared  for  during  the  last  year.  In  the  city  of 
Corning  there  is  one  hospital  taking  maternity  cases. 

There  is  a  public  health  nurse  in  Hornell  and  one  in  Corning, 
both  of  whom  are  giving  attention  to  infants  and  children  of  pre- 
school age.  Both  are  employed  by  the  local  Departments  of 
Health.  The  health  center  in  Hornell  has  both  infants  and  chil- 
dren of  pre-school  age  in  attendance.  There  is  a  day  nursery  in 
Hornell  with  54  children  cared  for  annually  and  the  Childrens 
Home  is  used  when  needed.  Thirty-four  children  are  cared  for 
there  annually. 

The  Metropolitan  Life  Insurance  Company  in  both  cities  is 
active  in  educational  work.  The  Corning  Glass  Works  is  co- 
operating in  this  work  in  Corning.  Health  education  throughout 
the  county  is  being  carried  on  through  the  County  Tuberculosis 
Committee. 

SUFFOLK  COUNTY 

Contains  23  civil  divisions  (11  townships,  12  incorporated 
villages) ,  and  has  a  population  of  109,682.  The  infant  mortality 
rate  in  1921  was  61. 

Health  supervision  is  provided  in  the  southern  half  of  the 
county  for  infants  and  expectant  mothers  through  six  visiting 
nurses  who  are  employed  by  and  under  the  direction  of  the  South 
Suffolk  County  Chapter  of  the  Red  Cross.  There  are  no  prenatal 
clinics.  About  150  expectant  mothers  were  reached  in  the  terri- 
tory of  the  Red  Cross  during  eight  months. 

There  are  six  hospitals  in  the  county  which  take  obstetrical 
cases.  The  county  hospital  is  at  Riverhead  and  the  others  are  pri- 
vate ones.  There  is  a  maternity  home  at  West  Hampton  Beach. 

Child  welfare  stations  are  located  in  four  communities,  Baby- 

116 


Ion,  Patchogue,  Islip  and  Amityville.  In  East  Hampton  the 
Neighborhood  House  has  started  a  child  welfare  station  which 
has  only  older  children  in  attendance,  and  is  under  the  direction 
of  a  social  worker.  The  visiting  nurse  carries  on  the  follow-up 
work. 

The  Red  Cross  is  not  active  in  infant  work  in  the  northern  part 
of  the  county.  Huntington  has  a  public  health  nurse  who  gives 
supervision  to  expectant  mothers  and  does  infant  work.  Smith- 
town  has  authorized  the  appointment  of  a  nurse  for  infant  work 
but  has  not  secured  her  yet.  There  are  a  number  of  school  nurses 
in  the  county  but  they  give  only  incidental  attention  to  infants 
and  children  of  pre-school  age. 

SULLIVAN  COUNTY 

Contains  19  civil  divisions  (15  townships  and  four  incor- 
porated villages),  and  has  a  total  population  of  34,904.  Its  infant 
mortality  rate  in  1921  was  71. 

There  are  no  prenatal  clinics  nor  child  welfare  stations  in  the 
county.  In  Liberty  printed  matter  on  these  subjects  has  been 
distributed  by  the  Council  of  Jewish  Women  which  also  has  done 
general  educational  work  in  all  districts  except  Lumberland,  High- 
land, Wurtsboro,  Tusten,  Fremont  and  Neversink.  The  Home 
Bureau  is  active  in  general  health  work  in  Liberty,  Delaware, 
Momakating,  and  Fallsburg,  where  child  welfare  exhibits  have 
been  held  and  lectures  given. 

There  is  one  dietition  for  the  county  employed  by  the  Home 
Bureau.  Classes  were  held  last  year  in  Call  icon,  Fallsburgh, 
Thompson  and  Liberty. 

There  are  no  hospitals  which  admit  obstetrical  cases.  In  a  few 
sections  a  shortage  of  physicians  has  been  reported  for  rural  calls. 

TIOGA  COUNTY 

Contains  15  civil  divisions  (nine  townships  and  six  incor- 
porated villages),  and  has  a  total  population  of  25,549.  Its  infant 
mortality  rate  for  1921  was  62. 

There  is  no  organized  work  for  maternity  and  infant  hygiene  in 
the  county,  although  some  educational  work  is  done  through  the 
representative  of  the  State  Charities  Aid  Association.  The  school 
nurse  for  the  township  of  Barton  sometimes  gives  advice  to  expect- 
ant mothers  in  the  village  of  Waverly. 

There  are  no  hospitals  in  the  county.    Single  clinics  for  chil- 

117 


dren  have  been  held  in  Waverly  and  Owego  where  mental  and 
physical  examinations  were  made.  These  were  organized  by  the 
county  agent  for  dependent  children  in  cooperation  with  the 
local  authorities. 

TOMPKINS  COUNTY 

Contains  16  civil  divisions  (one  city,  nine  townships  and  six 
villages) ,  and  has  a  total  population  of  36,535.  Its  infant  mortality 
rate  for  1921  was  78  in  the  rural  area  and  67  in  Ithaca. 

Supervision  for  expectant  mothers  is  provided  in  Ithaca  both 
through  clinics  and  home  visiting,  through  the  activities  of  the 
Visiting  Nurses  Association  and  Family  Welfare  Committee.  The 
Salvation  Army  also  does  some  educational  work  in  this  field. 
One  hospital  provides  twenty  beds  for  obstetrical  cases.  Five 
nurses  give  full  time  to  infant  work  and  to  children  of  pre-school 
age.  Children  of  all  ages  are  admitted  to  the  child  welfare  sta- 
tion. A  physician  and  nurses  are  in  attendance.  There  are  two 
milk  stations.  Three  of  the  school  playgrounds  are  open  to  chil- 
dren of  pre-school  age.  They  are  supervised  by  teachers. 

Throughout  the  rest  of  the  county  some  supervision  is  given 
to  expectant  mothers  through  the  Red  Cross  nurses.  In  all  about 
twenty-five  women  were  reached  last  year.  There  is  a  shortage  of 
physicians  for  rural  calls.  Educational  work  is  carried  on  by  the 
Home  Bureau  and  Red  Cross  by  means  of  child  welfare  exhibits, 
pamphlets  and  lectures. 

ULSTER  COUNTY 

Contains  28  civil  divisions  (one  city,  20  towns  and  seven 
incorporated  villages),  and  has  a  total  population  of  94,212.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  68,  and  in 
Kingston  76. 

No  supervision  is  given  to  expectant  mothers  throughout  this 
county,  and  there  are  no  child  welfare  stations,  but  some  educa- 
tional work  in  this  line  is  done  by  the  Home  Bureau  in  Rosendale, 
Denning,  Saugerties,  Gardiner,  Hurley  and  New  Platz. 

There  are  four  hospitals  in  the  county  which  provide  for 
obstetrical  cases;  one  in  Woodstock  and  three  in  Kingston,  where 
70  cases  were  cared  for  last  year.  A  physician  is  sent  out  for  home 
deliveries  in  Kingston.  An  insufficient  number  of  physicians  for 
rural  cases  is  reported  in  Denning. 

The  Home  Bureau  employs  a  nutrition  worker  in  Saugerties 

118 


and  the  manager  of  this  organization  in  Denning  gives  what  time 
she  can  to  instruction  of  this  kind.  A  milk  station  is  provided  in 
Saugerties.  In  several  places  lectures  are  given  and  in  Warwar- 
sing,  Denning  and  Ellenville  child  welfare  exhibits  have  been  held. 
In  Saugerties  the  Parent  Teachers  Association  promotes  this  work. 

WARREN  COUNTY 

Contains  13  civil  divisions  (one  city,  11  townships,  and  one 
incorporated  village),  and  has  a  total  population  of  33,887.  Its 
mortality  rate  for  infants  in  rural  districts  in  1921  was  58,  and  in 
Glens  Falls  88.  . 

There  is  no  organized  work  being  carried  on  in  the  county 
along  the  line  of  maternal  and  infant  hygiene  except  in  Glens 
Falls  and  Queensbury.  In  the  former  place  supervision  is  given 
expectant  mothers  in  the  homes  and  in  a  health  center  by  the 
board  of  health.  Thirty-five  women  were  reached  last  year.  Some 
of  the  mothers  of  Queensbury  attend  the  Glens  Falls  Health  Center 
and  some  work  is  done  in  their  town  by  the  Metropolitan  Life 
Insurance  Company,  but  this  is  limited  to  policy  holders.  N.  Creek 
formerly  employed  a  nurse  but  this  work  has  been  discontinued. 

There  is  one  hospital  in  Glens  Falls  which  takes  obstetrical 
cases  and  private  rooms  and  four  ward  beds  are  available.  This  is 
hardly  sufficient  to  meet  the  needs.  There  is  no  provision  made  for 
deliveries  in  the  home.  The  Association  Charities  gives  domestic 
help  during  confinement  where  it  is  needed. 

Two  public  health  nurses  are  employed  by  the  city  and  they 
give  part  of  their  time  to  infant  work. 

The  child  welfare  station  in  Glens  Falls  admitted  540  children 
under  school  age  last  year.  This  station  is  supervised  by  the 
board  of  health.  Follow  up  work  is  carried  on  by  the  nurses. 
Further  educational  work  is  done  through  children's  health  con- 
sultations, newspapers  and  child  welfare  exhibits. 

The  county  tuberculosis  nurse  does  some  general  educational 
work  in  rural  sections. 

WASHINGTON  COUNTY 

Contains  26  civil  divisions  (17  townships  and  nine  incor- 
porated villages) ,  and  has  a  total  population  of  51,287.  Its  infant 
mortality  rate  for  1921  was  66. 

The  only  supervision  given  in  maternity  and  infant  hygiene  is 
confined  to  the  villages  where  school  nurses  are  employed  and 

119 


this  is  only  incidental  and  in  connection  with  their  other  duties. 
These  villages  are  Fort  Edward,  Salem,  Granville,  Whitehall  and 
Cambridge. 

There  is  one  hospital  in  the  county  which  has  six  beds  for 
obstetrical  cases. 

Child  welfare  exhibits  have  been  held  in  a  few  places  and  it 
is  expected  that  a  child  welfare  station  will  be  opened  in  Gran- 
ville with  the  public  health  nurse  in  charge. 

WAYNE  COUNTY 

Contains  24  civil  divisions  (15  townships  and  nine  incor- 
porated villages,  and  has  a  total  population  of  51,287.  Its  infant 
mortality  rate  in  1921  was  65. 

There  is  no  organized  supervision  in  maternity  hygiene  and 
there  are  no  child  welfare  stations  in  the  county.  Educational 
work  is  being  done  through  the  county  Red  Cross  nurse  in  Sodus, 
Palmyra,  Mandon,  Huron,  Butler,  Savanah  and  Rose  townships. 

Private  hospitals  in  Sodus,  Newark  and  Lyons  occasionally 
take  obstetrical  cases.  One  midwife  is  registered  in  Newark. 

There  is  a  village  nurse  and  also  a  factory  nurse  in  Newark 
and  they  give  part  of  their  time  to  infant  work.  Child  welfare 
exhibits  have  been  held.  The  public  health  nurse  in  Lyons  also 
gives  part  of  her  time  to  infant  work.  Two  welfare  societies  in 
Lyons  provide  nursing  care  and  domestic  help  for  poor  mothers 
at  confinement. 

WESTCHESTER  COUNTY 

Contains  45  civil  divisions  (four  cities,  18  townships  and 
23  incorporated  villages) ,  and  has  a  total  population  of  101,477. 
Its  mortality  rate  for  infants  in  rural  districts  in  1921  was  85, 
White  Plains  68,  Yonkers  63,  Mount  Vernon  63,  New  Rochelle  61, 
Ossining  70,  Peekskill  72. 

Westchester  is  doing  more  than  any  other  county  in  the  state 
for  its  mothers  and  babies.  In  eight  communities  very  well 
organized  work  is  conducted  along  the  lines  of  maternity  hygiene. 
Yonkers,  Mount  Vernon,  New  Rochelle,  Bronxville,  White  Plains, 
Mamaroneck,  Peekskill  and  Ossining  report  clinics  or  health  cen- 
ters where  instruction  is  given  to  expectant  mothers.  Arrange- 
ments are  made  for  home  visiting  through  the  public  health  nurses 
in  the  towns  of  Eastchester,  Rye,  Lewisboro,  New  Castle,  Scars- 
dale,  Somers,  Greenburg  and  Tarrytown,  also  some  in  Katonah 

120 


Village.  The  Women's  Civic  League  in  Tarrytown  has  been 
interested  in  starting  a  prenatal  and  postnatal  clinic.  The  largest 
number  of  maternity  cases  in  the  county  which  are  under  the 
supervision  of  public  health  nurses  is  reported  from  the  city  of 
Mount  Vernon. 

Fourteen  hospitals  in  the  county  care  for  obstetrical  cases. 
The  County  Hospital  in  East  View  is  well  equipped  for  maternity 
cases,  but  as  yet  has  not  been  very  extensively  used,  only 
approximately  60  such  cases  having  been  cared  for  annually. 
This  number  should  be  doubled.  A  few  of  the  townships  report 
that  nursing  care  during  confinement  in  the  homes  is  provided 
through  local  authorities.  Fifty  midwives  are  registered  in  the 
county. 

Milk  of  excellent  quflity  is  supplied  in  some  of  the  larger 
centers,  but  milk  is  also  sold  in  many  of  them  which  is  below  the 
standard  set  by  the  State  Milk  Commission.  This  is  true  of 
Yonkers,  New  Rochelle,  Tarrytown,  Ossining  and  Irvington. 

Yonkers  employs  four  nurses  for  infant  work.  The  White 
Plains  Board  of  Health  employs  two  infant  welfare  nurses  and  the 
Ossining  District  Nursing  Association  also  employs  two.  In  the 
other  .cities,  townships  and  villages  the  public  health  nurses 
supervise  infant  care  along  with  their  other  duties. 

Sixteen  communities  report  child  welfare  stations  or  health 
centers,  Yonkers,  New  Rochelle,  Mount  Vernon,  Bronxville,  White 
Plains,  Mount  Kisco,  Larchmont,  Mamaroneck,  Portchester,  Rye 
Peekskill,  Ossining,  Hastings  during  summer  months,  Tarrytown, 
and  the  Purchase  Child  Hygiene  Clinic,  with  stations  at  Harrison 
and  Silver  Lake. 

Six  hundred  and  seven  children  attended  the  health  center  in 
Yonkers  last  year,  and  756  in  Mount  Vernon.  Tarrytown  village 
estimates  about  100  children  in  attendance  during  the  year. 

Nutrition  and  the  care  of  undernourished  children  is  taught  by 
the  school  nurses  as  well  as  the  district  nurses  wherever  they  are 
employed.  In  Rye  there  is  a  home  maintained  for  undernourished 
children. 

Day  nurseries  are  established  in  Yonkers,  Mount  Vernon,  New 
Rochelle,  Eastchester,  White  Plains,  Rye,  Ossining  and  Peekskill. 
A  day  nursery  is  reported  as  very  much  needed  in  the  town  of 
Portchester. 

121 


Table  IV* 


Maternity  Hygiene 

Infant  Hygiene 

Hospital 
Facilities 

Supervision 
by  Nurses 

Prenatal  Clinics 

Supervision 
by  Nurses 

Child  Welfare 
Stations 

"83 

6  '5. 
558 
W 

>> 
11 

'f 

Beds  'or 
Children 

|  Urban!  Rural  1  None|  Urban  |  Rural  |  None]  Urban  Rural|  None|Urban 

Rural]  None 

Albany  

X 

X 

x 

X 

X 

X 

x 

Total 

5 
1 
6 
3 
2 
3 
2 
1 
2 
1 
1 

67 
7 
67 
16 
4 
61 
11 
6 
12 
3 
20 

77 
4 

15 

5 
10 

11 

4 

6 

Allegheny  

x 

x 

X 

Broome  

X 
X 
X 

X 
X 

X 
X 

X 

X 
X 
X 

X 
X 

X 
X 

x 

X 
X 

Cattaragus  
Cayuga  
Chautauqua  .  .  . 
Chemung  
Chenango  

X 
X 
X 
X 

X 

X 

X 

x 

X 

x 

X 

X 

X 
X 

x 

x 

Clinton  

X 
X 
X 

X 
X 

X 
X 
X 

x 

Columbia  

X 

X 

x 

X 

x 

x 

Delaware  

X 
X 
X 
X 

x 

X 

Dut  chess  

X 
X 

X 
X 

X 
X 

X 
X 

x 

X 
X 

X 
X 

x 

4 

14 
2 
2 
1 
2 

36 
125 

13 

326 

Erie     

X 

x 

Essex  

Franklin  

x 

X 

x 

X 

12 
5 
11 

5 

Fulton      

X 
X 

X 
X 

X 

X 

x 

X 
X 

X 

x 

X 

x 

x 

Hamilton  

X 

x 

x 

X 
X 

Herkimer  
Jefferson  

X 
X 

X 

X 
X 

X 

X 
X 

X 
X 

x 

X 
X 

X 
X 

3 
2 

8 
31 

13 

Lewis  

x 

x 

X 

x 

X 

x 

x 

1 

6 

x 

x 

X 

X 

X 

x 

X 

X 
X 
X 
X 
X 
X 
X 
X 

X 

X 

x 

X 

6 
1 
1 
4 
9 
9 
2 
5 
2 
2 
2 

75 
20 

26 
117 

128 
8 
17 

01 
10 
10 
10 
62 
OS 
11 

ia 

Montgomery.  .  . 

X 

X 
X 
X 
X 
X 
X 

X 

X 
X 
X 

x 

X 

X 

X 

x 

X 

X 
X 

X 

X 
X 
X 

X 
X 

x 

X 
X 

Onondaga  
Ontario  

X 

X 

x 

X 

x 

X 

Orleans  

x 

x 

Oswego  

X 

X 

X 
X 

x 

6 
2 

• 

5 

Otsego 

x 

X 

x 

x 

Putnam  

x 

x 

X 

Rensselaer  

X 

X 

X 
X 

X 

X 

x 

x 

4 
3 
3 
2 
2 

42 

02 

X 
X 

x 

X 

X 

x 

St  Lawrence.  .  . 

x 

40 
3 
15 

40 
3 

12 

Saratoga  

x 

x 

x 

X 

Schenectady.  .  . 
Schoharie  

X 

X 

x 

X 

X 

x 

X 

X 

x 

X 

X 

x 

Schuyler  

x 

x 

x 

X 
X 

1 
2 
4 
0 

2 
12 

8 
7 

3 
113 

x 

x 

x 

X 

X 

X 

x 

Suffolk  

X 

x 

x 

x 

Sullivan  .  . 

x 

x 

x 

X 

X 

Tioga 

x 

x 

x 

Tompkins  
Ulster  .  .  . 

X 

X 

X 

X 

x 

1 
2 
1 
1 
1 
12 
1 

21 
14 

6 

7 

6 

6 

x 

x 

x 

X 

Warren 

X 

X 

X 

x 

X 

x 

x 

X* 

X 
X 

X 

X 
19 

Wayne 

x 

X 
X 

Westchester  .  .  . 

X 

X 

x 

X 

X 

x 

X 

x 

X 

X 

97 

133 

Yates  

x 

x 

x 

Total  Counties. 

29 

25 

21 

26 

7 

29 

31 

30 

17 

31 

21 

146 

1,171 

1.206 

*  Credit  is  given  under  the  respective  headings  if  work  is  carried  on  in  a  single  com- 
munity. The  extent  of  such  work  can  be  ascertained  by  referring  to  the  county  summary  .and 
page  74. 


122 


WYOMING  COUNTY 

Has  25  civil  divisions  (16  townships  and  nine  incorporated 
villages),  and  has  a  total  population  of  32,950.  Its  infant  mor- 
tality rate  in  1921  was  74. 

No  work  along  the  line  of  maternal  and  infant  hygiene  has 
been  inaugurated  in  this  county  and  no  supervision  is  given 
expectant  mothers  either  in  clinics  or  in  their  homes.  There  is 
one  hospital  in  Warsaw  but  this  does  not  care  for  obstetrical 
cases.  There  are  thirty  beds  in  the  hospital  which  is  not  large 
enough  to  meet  the  needs  of  the  community.  Warsaw  and  Perry 
each  have  a  maternity  home. 

For  a  year  a  school  nurse  was  employed  in  Warsaw  by  the  Red 
Cross.  Her  work  was  discontinued  because  of  lack  of  funds. 

There  are  no  health  centers  or  welfare  stations  in  the  county 
and  no  educational  work  is  being  done  in  dietetics  or  for  children 
of  pre-school  age. 
YATES  COUNTY 

Contains  13  civil  divisions  (nine  townships  and  four  incor- 
porated villages),  and  has  a  total  population  of  18,841.  Its  infant 
mortality  rate  in  1921  was  79. 

There  is  no  organized  supervision  of  expectant  mothers,  and 
there  are  no  child  welfare  stations  in  the  county. 

The  county  tuberculosis  nurse  gives  some  directions  to  expectant 
mothers  and  instruction  in  baby  care  as  she  comes  in  contact  with 
these  cares,  but  her  work  has  been  more  with  older  children,  in 
organizing  tonsil  and  adenoid  clinics,  etc.  One  hospital  which  is 
located  in  Penn  Yan  cared  for  about  twelve  obstetrical  cases  during 
the  past  year. 

TABLE  V 
Prenatal  Clinics  and  Child  Welfare  Stations  in  Cities 

Child      Infant  Mortality 
Welfare    Rate  (Av'ge.  of 
last  three  years) 
79 
101 
78 


Population 

Jst  class 

Cities 

Pop.  over 

New  York 

175,000 

Buffalo 

Rochester 

2nd  class 

Pop.  50,000 

Albany 

to 

Binghamton 

175,000 

Niagara  Falls 

Schenectady 

Syracuse 

Troy 

Utica 

Yonkers 

Prenatal  Clinics    Stations 


79 
88 
99 
75 
89 
103 
84 
77 


123 


TABLE   V— (Continued) 


Population 


3rd  class  (A) 
Pop.  20,000 

to 
50,000 


3rd  class  (B) 
Pop.  10,000 

to 
20,000 


3rd  class  (C) 
Pop.  under 
10,000 


Cities 

Amsterdam 

Auburn 

Cohoes 

Elmira 

Gloversville 

Jamestown 

Kingston 

Lockport 

Mount  Vernon 

Newburgh 

New  Rochelle 

Olean 

Oswego 

Poughkeepsie 

Rome 

Watertown 

White  Plains 

Batavia 

Beacon 

Corning 

Cortland 

Dunkirk 

Fulton 

Geneva 

Glens  Falls 

Hornell 

Hudson 

Ithaca 

Johnstown 

Lackawanna 

Little  Falls 

Middletown 

North  Tonawanda 

Ogdensburg 

Oneida 

Oneonta 

Peekskill  (village) 

Plattsburg 

Port  Chester  (village) 

Port  Jervis 

Rensselaer 

Saratoga  Springs 

Tonawanda 

Watervliet 

Canandaigua 
Glen  Cove 
Mechanicsvillc 
Norwich 

Ossining  (village) 
Salamanca 

Total  No.  of  Cities 

124 


Prenatal 
Clinics 


Child  Infant  Mortality 
Welfare  Rate  (Av'ge.  of 
Stations  last  three  years) 


33 


47 


89 
89 

107 
72 
78 
74 
85 

101 
68 
85 
67 
84 
83 
85 
86 

103 
65 


75 
68 
77 
72 
53 
93 


TABLE  VI 
Prenatal  Clinics  and  Child  Welfare  Stations  in  Villages 

Villages  Prenatal  Clinics  Child  Welfare  Stations 

Amityville 

Babylon 

Bronxville 

Catskill 

Clark  Mills 

Clinton 

Dansville 

Endicott 

Fredonia 

Geneseo 

Gowanda 

Grand  View 

Great  Neck  *  * 

Hastings  Summer 

Haverstraw 

Hounsfield 

I  lion 

Islip 

Johnson  City 

Kenmore 

Larchmont 

Lancaster 

Lawrence  * 

Le  Roy 

Locust  Valley 

Mamaroneck  * 

Massena 

Mount  Kisco 

Mohawk  * 

North  Tarrytown 

Nyack 

Ossining  * 

Patchogue  * 

Peekskill  *  * 

Port  Chester 

Port  Washington 

Purchase 

Rhinebeck 

Roslyn  * 

Rye 

Solvay 

Upper  Nyack  * 

Warwick 

Weedsport 

Westbury  * 

Williamsville  * 

Total  villages  10  46 

125 


Year 
1920 


TABLE  VII 

Children's  Health  Consultations  and  Healthniobile  Visits 

Conducted  by  the  Child  Hygiene  Division  of  the  State 

Department  of  Health 

County                       No.  Places  Visited  No.  Children  Examined 

Chenango                                    21  680 

Fulton                                          13  126 

Livingston                                   19  488 

Orange                                        20  710 

Schoharie                                    18  388 


99 


2725 


1921     Allegany 
Cattaraugus 
Clinton 
Dutchess 
Erie 

8 
10 
2 

1 
3 

568 
557 
29 
32 

275 

Essex 

3 

% 

Franklin 

1 

(Ind.  Res/ 

) 

189 

Herkimer 

2 

205 

Jefferson 

9 

592 

Lewis 

5 

256 

Madison 

1 

81 

Niagara 

9 

396 

Oneida 

3 

211 

Orleans 

10 

307 

Oswego 

9 

482 

Otsego 

8 

290 

Putnam 

4 

187 

St.  Lawrence 

10 

462 

Suffolk 

5 

92 

Warren 

8 

262 

Wayne 

1 

40 

112 

5609 

Grand  Total 

211 

8334 

TABLE 

VIII 

Little 

Day 

Cities 

Milk  Stations 

Mothers'  Leagues 

Nurseries 

Playgrounds* 

Albany 

2 

5 

2 

5 

Amsterdam 

No 

No 

1 

Day  Nursery 

Auburn 

1  in  summer 

No 

1 

8 

Batavia 

No 

No 

No 

3 

Beacon 

No 

Yes 

No 

3 

Binghamton 

No 

No 

1 

20 

Milk  is  given  on 

1  public 

Buffalo           recommendation  of  nurses 

Yes 

5  private 

16 

Canandaigua 

No 

No 

No 

No 

Cohoes 

1 

Yes 

1 

3 

Corning 

No 

No 

No 

1 

Cortland 

No 

No 

No 

? 

Dunkirk 

No 

Summer 

months 

1 

Day  nursery 

Elmira 

No 

No 

1 

2 

*  Most  of  these  are  school  playgrounds  which  are  open  to  pre-school  children  also. 


126 


TABLE  VIII— (Continued) 


Cities 


Fulton 

No 

Geneva 

No 

Glen  Cove 

Yes 

Glens   Falls 

1 

Gloversville 

No 

Hornell 

No 

Hudson 

No 

Ithaca 

2 

Jamestown 

No 

Johnstown 

No 

Kingston 

No 

Lacka  wanna 

No 

Little  Falls 

No 

Lockport 

No 

Mechanicville 

No 

Middletown 

No 

Mount  Vernon 

No 

Newburg 

No 

New   Rochelle 

2 

Niagara  Falls 

No 

North  Tonawanda 

No 

Norwich 

No 

Ogdensburg 

No 

Olean,  for  undernourished 

Oneida 

No 

Oneonta 

No 

Ossining    Village 

1 

Oswego 

No 

Peekskill  Village 

No 

Plattsburg 

No 

Port  Chester  Village 

1 

Port  Jervis 

No 

Poughkeepsie 

No 

Rensselaer 

No 

Rochester 

2 

Rome 

No 

Salamanca 

No 

Saratoga   Springs 

No 

Schenectady 

No 

Syracuse 

No 

Tonawanda 

? 

Troy 

1 

Utica 

2 

Watertown 

No 

Watervliet 

No 

White  Plains 

No 

Yonkers 

4 

Total  60 

12 

Milk  Stations      Mothers' Leagues          Nurseries    Playgrounds 


Yes 
Yes 

2 

No 
Yes 
No 
No 
No 
Yes 
No 
No 
No 
No 
No 

p 

No 
No 
No 
Yes 
Yes 

1 

No 
No 

2 

Yes 
No 
No 

1 

? 

Yes 
Yes 
No 

3 
p 

Yes 

? 

No 
No 
Yes 
Yes 
No 
Yes 
Yes 
No 
No 
Yes 
Yes 
25 


No 

1 

1 

4 

No 

2 

No 

School 

1 

No 

1 

1 

No 

No 

No 

3 

1 

7 

No 

No 

No 

No 

No 

1 

1 

5 

No 

No 

No 

? 

1 

3  for  schools 

1 

2,  1  sch.,  1  nurs. 

1 

1 

1 

Schools 

No 

5 

No 

No 

No 

No 

No 

No 

No 

7 

No 

No 

No 

School 

1 

1 

No 

No 

Yes 

No 

No 

No 

No 

School 

No 

Yes 

1 

6 

No 

p 

2 

Yes 

No 

? 

No 

? 

No 

No 

27 

3  parks 

1 

Yes 

No 

? 

2 

8 

2 

15 

No 

No 

No 

No 

1 

1  summer 

1 

1  school,  1  park 

27 

39 

127 


SUMMARY 

I.     PRENATAL  CARE 

Provision  by  local  communities  for  the  supervision  of  expectant 
mothers  is  one  of  the  newer  fields  of  public  health  work  and  in 
most  counties  very  little  is  being  done  except  in  the  large  cities. 
In  21  counties  nothing  is  being  done  whatever.  Half  of  the  cities 
in  this  state  now  have  prenatal  clinics  with  physicians  and  nurses 
in  attendance  where  women  can  come  for  examination  and 
advice.  Thirteen  of  our  larger  villages  have  also  provided  clinics. 
In  all,  forty-three  communities  are  supporting  such  work  either 
through  public  or  private  funds  or  a  combination  of  both.  In 
most  cases  these  clinics  or  health  centers  are  established  first 
through  the  activity  of  some  private  organization  and  later  taken 
over  by  the  municipality.  Twenty-nine  cities,  six  of  which  have  a 
population  of  over  20,000,  have  as  yet  no  prenatal  clinics.  In 
some  of  these  cities  supervision  and  general  instructions  in  the 
hygiene  of  pregnancy  are  given  through  visiting  nurses  who  come 
in  contact  with  women  in  their  homes  while  on  other  duties,  and 
who  keep  in  touch  with  them.  Such  an  arrangement  in  a  city 
is  valuable  when  carried  on  in  connection  with  a  clinic,  but  cannot 
take  the  place  of  the  latter. 

In  the  villages  which  have  one  or  more  community  nurses 
supervision  is '  sometimes  given  to  expectant  mothers.  This  con- 
sists usually  of  a  few  visits  with  simple  instructions.  Most  of  these 
nurses  do  bedside  work  in  addition  to  the  public  health  work,  and 
many  have  the  visiting  of  schools  included  in  their  various  duties, 
so  maternity  hygiene  activities  are  more  or  less  incidental  and 
occur  simply  as  the  nurse  comes  in  contact  with  such  cases  in  the 
families  of  school  children  which  she  is  visiting,  etc. 

Throughout  rural  sections  practically  nothing  is  being  done 
except  in  a  very  few  counties  which  are  fairly  thickly  populated, 
notably  Erie,  Dutchess,  Livingston,  Monroe,  Nassau,  Rockland 
and  Westchester.  Each  of  these  counties  either  contains  or  is 
adjacent  to  a  ctiy  of  the  first  class  except  Dutchess.  In  Chemung 
the  county  nurse  undertook  a  piece  of  demonstration  work  in  this 
field  last  year.  She  visited  women  in  rural  sections  and  had  twenty 
cases  under  her  supervision.  About  300  babies  are  born  annually 
in  this  county,  so  she  had  about  6%  of  all  such  cases  under 
her  care. 

129 


Attempts  to  establish  prenatal  work  have  been  made  but  given 
up  in  a  few  places.  The  cause  of  such  a  failure  is  sometimes  laid 
at  the  door  of  local  physicians  for  their  lack  of  cooperation.  Some- 
times the  personality  of  the  nurse  is  held  responsible,  and  some- 
times the  local  committee  has  failed  to  make  the  most  suitable 
arrangements  for  the  work. 

We  found  no  communities  in  which  special  protection  was 
given  to  expectant  mothers  in  industry  or  that  had  maternity 
benefits  or  insurance. 

II.     CARE  AT  BIRTH. 

In  forty-one  counties  some  public  provision  is  made  for  hospital 
care  of  maternity  cases  and  in  five  more  there  are  small  private 
hospitals  which  occasionally  take  emergency  cases.  Eleven  coun- 
ties have  no  hospitals.  These  are  Delaware,  Essex,  Greene,  Ham- 
ilton, Lewis,  Putnam,  Schoharie,  Sullivan,  Tioga,  Wyoming  and 
Yates.  In  only  the  largest  cities  are  any  arrangements  made  for 
delivery  of  women  in  their  own  homes  by  physicians  sent  from 
the  hospitals.  (See  Table  4.) 

The  number  of  physicians  available  for  rural  calls  is  often 
insufficient.  There  are  about  250  municipalities  at  the  present 
time  which  have  no  physician,  and  a  number  of  cases  were 
reported  where  no  physician  could  be  obtained.  Sometimes  a 
nurse  can  reach  these  women,  but  in  most  cases  there  are  only 
members  of  the  family  or  a  neighbor  in  attendance.  In  moun- 
tainous counties  the  nurses  have  to  travel  on  horseback  and  we 
occasionally  get  reports  of  great  hardships  endured  such  as 
crossing  through  rapids  in  a  canoe  at  night  during  the  win- 
ter to  go  to  a  woman  in  confinement.  The  shortage  of  physi- 
cians in  rural  communities  has  become  a  very  serious  problem. 
Two  factors  have  been  bringing  this  about.  In  the  first  place, 
fewer  physicians  are  graduating  from  the  medical  schools.  This 
is  due  both  to  a  reduction  in  the  number  of  medical  schools  and  to 
a  raising  of  the  requirements  and  standards  of  work  in  the  schools 
which  remain.  These  schools  can  take  also  only  a  limited  number 
of  students.  The  result  is  that  while  the  efficiency  and  quality  of 
medical  work  have  been  greatly  improved,  the  total  number  of 
physicians  available  is  about  one-third  what  it  was  thirty  years 
ago.  The  second  factor  in  creating  a  shortage  in  rural  sections  is 
the  tendency  of  these  physicians  to  locate  in  cities.  The  average 

130 


period  of  a  physician's  practice  has  been  estimated  at  about  30 
years,  and  a  very  large  proportion  of  the  men  in  country  practice 
are  nearing  the  end  of  their  active  years.  The  average  age  of  the 
health  officers  in  the  state  today  is  considerably  over  50  years  and 
"large  numbers  of  our  health  officers  are  men  of  sixty-five,  seventy, 
seventy-five,  and  some  even  eighty  years  of  age."* 

According  to  a  regulation  of  the  Public  Health  Council  no  one 
should  be  appointed  a  health  officer  who  is  over  sixty-five,  but  in 
many  municipalities  the  only  physician  in  the  community  is  over 
this  age  limit  and  as  these  men  die  or  retire  it  is  difficult  to  fill 
their  places.  Eighty-two  municipalities  appealed  to  the  State 
Department  of  Health  because  they  had  no  medical  service  of 
any  kind,  and  thirty-four  of  the  vacancies  were  filled. 

The  control  of  the  practice  of  midwifery  was  placed  under  the 
State  Department  of  Health  in  1914.  Since  that  time  an  annual 
renewal  of  a  license  to  practice  has  been  required,  and  the  method 
of  checking  up  the  names  of  midwives  reporting  births  with  the 
list  of  those  licensed,  as  well  as  investigation  of  all  instances  of 
reported  practice  without  a  license,  has  resulted  in  about  doubling 
the  total  number  of  licenses  issued.  This  does  not  represent  an 
increased  tendency  to  call  on  midwives,  however,  for  the  actual 
number  of  births  attended  by  midwives  has  dropped  from  16%  in 
1916  to  12.4%  in  1920.  It  is  also  of  interest  that  about  80%  of 
white  mothers  under  midwife  care  are  foreign  born.  In  1921,  432 
licenses  were  issued  in  this  state,  exclusive  of  New  York  and 
Rochester.  Thirteen  licenses  were  withheld,  two  were  cancelled, 
and  there  was  one  prosecution.  Fifty-two  new  applications  were 
received,  and  twenty-two  were  able  to  qualify. 

One  of  the  most  urgent  needs  both  in  cities  and  rural  com- 
munities is  for  domestic  help  during  the  period  of  confinement. 
In  a  very  few  places  arrangements  of  this  sort  are  made  by  private 
organizations,  but  it  is  much  more  common  t<3  find  nursing  care 
provided.  This  consists  usually  of  a  brief  daily  visit  and  poor 
mothers  are  frequently  obliged  to  get  up  too  soon  after  confine- 
ment in  order  to  attend  to  their  household  duties  and  other 
children. 


('From  abstract  of  an  address  by  Hermann  M.  Biggs,  M.D.,  LL.D.,  Com- 
missioner of  Health,  at  the  annual  Convention  of  the  N.  Y.  State  League  of 
Women  Voters,  in  Albany,  January,  1922.) 

131 


III.     CARE  OF  THE  INFANT  AND  CHILD  OF  PRE-SCHOOL  AGE. 

Each  of  the  cities  with  a  population  of  over  50,000  employs 
several  public  health  nurses  who  devote  their  entire  time  to  infant 
work  alone  or  to  this  plus  work  with  children  of  pre-school  age. 
These  cities  are  Buffalo,  Rochester,  Albany,  Binghamton,  Niagara 
Falls,  Schenectady,  Syracuse,  Troy,  Utica  and  Yonkers.  Of  the 
remaining  48  cities  only  10  have  one  or  more  full-time  nurses  for 
infant  work.  These  are  Oswego,  Poughkeepsie,  Rome,  Watertown, 
White  Plains,  Batavia,  Dunkirk,  Fulton,  Ithaca  and  Lackawanna. 
One  village,  Ossining,  employs  two  full-time  infant  welfare  nurses, 
and  averaging  figures  for  the  last  three  years,  this  community  has 
had  the  lowest  infant  mortality  rate  of  any  city,  town  or  village 
during  that  period.  This  rate  is  53  (i.e.,  babies  under  one  year 
of  age  die  at  the  rate  of  53  out  of  1,000  living  births) .  The  gen- 
eral urban  mortality  rate  throughout  New  York  State  during  that 
period  was  87  and  the  rural  mortality  rate  was  76. 

In  most  large  cities  the  nurses  are  employed  by  the  depart- 
ments or  boards  of  health.  In  smaller  places  the  Red  Cross  or 
visiting  nurses  association  often  assumes  the  responsibility  either 
entirely  or  jointly  with  the  municipality.  In  rural  sections  the 
county  nurses  employed  by  tuberculosis  societies  and  Red  Cross 
organizations  are  frequently  giving  some  of  their  time  to  infant 
work.  This  is  usually  more  of  an  educational  nature  than  direct 
supervision  of  individual  babies.  Lectures,  child  welfare  exhibits 
and  home  nursing  classes  provide  opportunity  for  instructing 
mothers  in  the  fundamentals  of  baby  care,  and  these  organizations 
are  often  found  cooperating  with  local  clubs  and  the  State  Depart- 
ment of  Health  in  arranging  for  single  clinics  or  child  health  con- 
sultations. Usually  there  is  but  one  nurse  for  the  entire  county 
and  she  is  engaged  in  all  forms  of  public  health  activity,  with  most 
of  her  time  devoted  to  tuberculosis  work.  This  means  that  she 
can  reach  only  a  small  part  of  the  county  with  her  infant  welfare 
work.  In  some  counties  these  nurses  do  no  infant  work  at  all. 
Much  depends  upon  the  policy  of  the  county  committees.  If  they 
are  organized  primarily  as  anti-tuberculosis  societies  it  is  only 
natural  that  their  activities  should  be  limited  to  that  field  and 
only  incidental  attention  given  to  questions  of  maternity  and 
infancy  hygiene.  The  latter  are  considered  simply  in  relation  to 
the  problem  of  prevention  of  tuberculosis.  In  some  counties  the 
Home  Bureaus  do  educational  work  in  the  field  of  baby  care 

132 


through  their  nutrition  workers.  The  county  boards  of  child  wel- 
fare have  charge  only  of  the  granting  of  allowances  to  needy 
families. 

Child  Welfare  Stations  are  located  in  92  communities  in  this 
state.  (See  Map  p.  74  and  Tables  V  &  VI.)  The  majority  of  these 
have  chiefly  infants  in  attendance  but  some  receive  also  children 
of  pre-school  age.  In  the  large  cities  these  are  open  daily,  but  in 
a  number  of  villages  they  are  open  once  a  week,  once  in  two 
weeks,  or  once  a  month.  Single  annual  clinics  have  not  been 
included  in  this  list.  The  child  welfare  stations  are  usually  main- 
tained by  the  same  organizations  that  employ  the  public  health 
nurses. 

The  work  that  is  being  done  by  the  Division  of  Maternity, 
Infancy  and  Child  Hygiene  of  the  State  Department  of  Health 
must  be  mentioned  here.  This  consists  of  single  clinics  or  chil- 
dren's health  consultations  held  in  small  communities  with  the 
cooperation  of  local  committees.  Physicians  and  nurses  are  sent 
by  the  State  Department  and  examinations  are  made  of  children 
and  advice  as  to  treatment  given  to  parents.  The  follow-up  work 
is  placed  as  far  as  possible  in  the  hands  of  local  agencies.  A 
travelling  automobile  clinic  called  the  "healthmobile"  is  used  on 
many  of  these  occasions,  and  it  has  proved  to  be  very  successful 
and  popular.  Moving  pictures  are  shown  and  informl  talks  are 
given.  During  1920  six  counties  were  visited  with  2,725  children 
examined,  and  in  1921  5,609  children  were  examined  in  twenty- 
one  counties.  (See  table  VII). 

The  milk  supply  varies  a  great  deal  in  quality  in  different 
sections  of  the  state.  A  great  deal  of  milk  is  being  sold  which 
comes  from  non-tuberculin  tested  cows  and  the  communities  which 
maintain  the  standards  set  by  the  New  York  State  Milk  Commis- 
sion are  few  in  number.  The  Commission  recommended  that  all 
milk  of  Grade  B  or  under  should  be  pasteurized,  and  that  milk  for 
retail  trade  should  be  sold  in  bottles.  In  most  of  our  large  cities 
this  milk  is  pasteurized,  but  dip  milk  is  still  being  sold.  Eight 
cities  and  villages  reported  that  all  milk  of  Grade  B  and  C  was 
pasteurized  and  that  bottles  were  always  used  for  retail  trade. 
These  were  Buffalo,  Elmira,  Poughkeepsie,  Schenectady,  Canan- 
daigua,  Geneva,  Newark  and  Hastings-on-Hudson.  Milk  stations 
which  supply  needy  families  with  milk  either  free  or  at  small  cost 
are  found  in  12  communities.  (See  table  VIII.) 

133 


One  of  the  educational  measures  most  frequently  found  in  both 
cities  and  villages  is  the  Little  Mothers  League.  This  is  a  group 
of  young  girls  over  12  years  of  age  who  are  taught  personal  hygiene 
and  methods  of  baby  care.  Such  leagues  were  reported  from  25 
communities. 

Day  nurseries  are  found  in  27  cities  and  are  usually  main- 
tained by  private  funds.  Playgrounds  which  are  open  to  pre- 
school children  were  found  in  39  communities.  A  few  of  these 
are  in  connection  with  the  day  nurseries  and  many  of  the  others 
are  the  regular  school  playgrounds  which  are  designed  primarily 
for  older  children.  The  need  of  supervised  play  for  children  of 
this  age  period  has  hardly  been  recognized  yet. 

RECOMMENDATIONS 

1.  Maternity  hospitals  should  be  established  or  provisions  for 
proper   maternity   care   made    available   in   every   county   of   the 
state.     No  woman  should  have  to  face  the  possibility  of  neglect 
or  lack  of  proper  care  at  this  extremely  important  crisis  of  her  life. 
The  establishment  of  maternity  hospitals  can  serve  as  a  further 
inducement  for  getting  competent  physicians  to  care  for  the  medi- 
cal practice  of  the  community.     One  such  hospital  may  be  made 
to  serve  one  or  more  counties. 

2.  In  those  parts  of  the  state  where  women  have  to  depend 
upon  midwives,  there  should  be  an  insistence  upon  local  regis- 
tration and  the  necessary  supervision  which  will  maintain  the  prac- 
tice of  these  women  at  a  standard  at  least  as  high  as  that  which 
is  demanded  by  the  State  Department  of  Health.     The  method 
which  ignores  the  midwife  and  allows  her  to  practice  without 
supervision  we  believe  to  be  deplorable  and  we   are  convinced 
that  the  maintenance  of  a  high  type  of  midwifery  is  essential  if 
we  hope  to  reduce  the  maternal  mortality  rate  and  the  deaths  at 
birth  or  during  the  first  few  days  of  life. 

S.  The  high  death  rate  of  infants  during  the  first  month  of 
life  calls  attention  to  the  serious  need  of  better  prenatal  condi- 
tions and  care.  It  is  not  suggested  that  each  county  establish  pre- 
natal clinics  at  once  but  a  beginning  in  this  direction  should  be 
made  and  prenatal  work  can  ultimately  become  a  valuable  part 
of  the  work  of  the  maternity  hospitals.  Where  infant  welfare  sta- 
tions or  baby  health  stations  or  child  welfare  stations  are  main- 
tained, prenatal  care  should  be  a  part  of  their  function  and  it  is  not 

134 


too  much  to  hope  that  even  the  county  nurse,  with  her  many 
duties,  may  feel  that  one  of  the  most  important  is  to  see  that  every 
pregnant  woman  with  whom  she  comes  into  contact  has  the  proper 
advice  and  supervision. 

4.  For  the  reduction  of  the  infant  mortality  rate,  baby  health 
stations  or  visiting  nurses  should  be  maintained  in  every  part  of 
the  state,  sufficient  to  see  that  no  baby  who  otherwise  would  be 
neglected  goes  without  proper  supervision.     In  the  present  stage 
of  our  knowledge  of  the  effectivenss  of  public  health  work  for 
the  prevention  of  infant  mortality,  a  one  hundred  per  cent  pro- 
gram of  efficiency  must  be  considered  the  minimum.     No  county, 
no  city,  town  or  village  can  afford  to  do  less  than  give  its  babies 
every  measure  of  protection.     There  is  no  reason  why  the  baby 
death  rate  in  New  York  State  outside  of  New  York  City  should  be 
higher  than  that  in  New  York  City;  there  is  every  reason  why  it 
should  be  lower.     Cities  and  towns  where  sufficient  infant  welfare 
nurses  have  been  used  report  low  baby  death  rates;  those  with 
inadequate  supervision  show  invariably  high  death  rates.     Every 
unnecessary  infant  death  is  an  indictment  of  the  lax  method  of 
the  community.     In  no  field  of  public  health  work  are  the  results 
more  sure  and  certain  nor  can  more  valuable  results  be  obtained 
for  the  money  expended  than  in  the  field  of  infant  welfare  work. 
The  infant  death  rate  of  New  York  State  can  be  reduced  just  as 
rapidly  as  its  citizens  choose  to  accomplish  this  result. 

5.  In  all  child  welfare  stations  provision  should  be  made  for 
the  child  of  pre-school  age.     This  age,  from  two  to  six  years,  rank- 
ing as  it  does  next  to  infancy  in  its  high  death  rate  and  even  more 
susceptible  than  the  period  of  infancy  to  the  sicknesses  and  deaths 
caused  by  infectious  diseases,  is  one  which  is  rapidly   claiming 
attention.  Children  of  pre-school  age  should  have  a  physical  exam- 
ination at  least  once   a  year,  their  mothers  should  have  health 
instruction  both  in  the  stations  and  at  home  and  the  child  at  this 
hitherto  neglected  but  increasingly  important  period  of  life  should 
have  the  same  health  care  that  is  being  suggested  and  in  many 
cases  provided  for  the  infant  and  school  child. 

To  summarize,  New  York  State  at  the  present  time  has  an 
indefensibly  high  infant  mortality  rate  and  a  maternal  mortality 
rate  that  are  capable  of  great  reduction.  The  methods  of  reducing 
both  of  these  rates  have  been  clearly  outlined  and  the  necessary 
supervision,  instruction  and  guidance  are  available  under  the 

135 


Division  of  Maternity,  Infancy  and  Child  Hygiene  of  the  State 
Department  of  Health.  It  remains  for  each  local  community  to 
do  its  part.  Only  by  the  maintenance  of  properly  equipped  child 
welfare  stations,  sufficient  and  effective  maternity  hospitals  or 
other  maternity  service  and  the  use  of  visiting  nurses  for  rural 
communities  can  this  be  achieved.  If  New  York  State  chooses,  it 
can  have  the  lowest  maternal  and  infant  mortality  rates  of  all  the 
States  in  the  Union.  It  is  simply  a  question  of  local  interest,  mod- 
erate expenditure  and  the  following  of  well-established  methods. 


136 


APPENDIX 

EDUCATION  LAW 

ARTICLE  20A 
Medical  Inspection 

§  570  MEDICAL  INSPECTION  TO  BE  PROVIDED.  Medical  inspec- 
tion shall  be  provided  for  all  pupils  attending  the  public  schools 
in  this  State,  except  in  cities  of  the  first  class,  as  provided  in  this 
article.  Medical  inspection  shall  include  the  services  of  a  trained 
registered  nurse,  if  one  is  employed,  and  shall  also  include  such 
services  as  may  be  rendered  as  provided  herein  in  examining 
pupils  for  the  existence  of  disease  or  physical  defects  and  in  test- 
ing the  eyes  and  ears  of  such  pupils.  [Added  by  L.  1913,  ch.  627.] 

§  571  EMPLOYMENT  OF  MEDICAL  INSPECTORS.  The  board  of 
education  in  each  city  and  union  free  school  district,  and  the 
trustee  or  board  of  trustees  of  a  common  school  district,  shall 
employ,  at  a  compensation  to  be  agreed  upon  by  the  parties,  a 
competent  physician  as  a  medical  inspector,  to  make  inspections  of 
pupils  attending  the  public  schools  in  the  city  or  district.  If 
appointed  by  a  board  of  education  of  a  city  such  physician  shall 
reside  within  the  city.  The  physicians  so  employed  shall  be  legally 
qualified  to  practise  medicine  in  this  State,  and  shall  have  so 
practised  for  a  period  of  at  least  two  years  immediately  prior  to 
such  employment.  Any  such  board  or  trustees  may  employ  one  or 
more  school  nurses,  who  shall  be  registered  trained  nurses  and 
authorized  to  practise  as  such.  Such  nurses  when  so  employed 
shall  aid  the  medical  inspector  of  the  district  and  shall  perform 
such  duties  for  the  benefit  of  the  public  schools  as  may  be  pre- 
scribed by  such  inspector. 

A  medical  inspector  or  school  nurse  may  be  employed  by  the 
trustees  or  boards  of  education  of  two  or  more  school  districts, 
and  the  compensation  of  such  inspector,  and  the  expenses  incurred 
in  making  inspections  of  pupils  as  provided  herein,  shall  be  borno 
jointly  by  such  districts,  and  be  apportioned  among  them  accord- 
ing to  the  assessed  valuation  of  the  taxable  property  therein. 

137 


In  cities  and  union  free  school  districts  having  more  than  five 
thousand  inhabitants,  the  board  of  education  may  employ  such 
additional  medical  inspectors  as  may  be  necessary  to  properly 
inspect  the  pupils  in  the  schools  in  such  cities  and  union  free 
school  districts. 

The  trustees  of  a  common  school  district  or  the  board  of  educa- 
tion of  a  union  free  school  district  whose  boundaries  are  cotermi- 
nous with  the  boundaries  of  an  incorporated  village  shall,  in  the 
employment  of  medical  inspectors,  employ  the  health  officer  of  the 
town  in  which  such  common  school  district  is  located  or  the  health 
officer  of  such  union  free  school  district,  so  far  as  may  be  advan- 
tageous to  the  interests  of  such  district.  [Added  by  L.  1913,  ch.  627, 
and  amended  by  L.  1916,  ch.  182.] 

§  572  PUPILS  TO  FURNISH  HEALTH  CERTIFICATES.  A  health 
certificate  shall  be  furnished  by  each  pupil  in  the  public  schools 
upon  his  entrance  in  such  schools,  and  thereafter  at  the  opening 
of  such  schools  at  the  beginning  of  each  school  year.  Each  certifi- 
cate shall  be  signed  by  a  duly  licensed  physician  who  is  authorized 
to  practise  medicine  in  this  State,  and  shall  describe  the  condition 
of  the  pupil  when  the  examination  was  made,  which  shall  not  be 
more  than  thirty  days  prior  to  the  presentation  of  such  certificate, 
an3  state  whether  such  pupil  is  in  a  fit  condition  of  bodily  health 
to  permit  his  or  her  attendance  at  the  public  schools.  Such  certifi- 
cate shall  be.  submitted  within  thirty  days  to  the  principal  or 
teacher  having  charge  of  the  school  and  shall  be  filed  with  the 
clerk  of  the  district.  If  such  pupil  does  not  present  a  health 
certificate  as  herein  required,  the  principal  or  teacher  in  charge  of 
the  school  shall  cause  a  notice  to  be  sent  to  the  parents  of  such 
pupil  that  if  the  required  health  certificate  is  not  furnished  within 
thirty  days  from  the  date  of  such  notice,  an  examination  will  be 
made  of  such  pupil  as  provided  herein.  [Added  by  L.  1913, 
ch.  627.] 

§  573  EXAMINATIONS  BY  MEDICAL  INSPECTORS.  Each  principal 
or  teacher  in  charge  of  a  public  school  shall  report  to  the  medical 
inspector  having  jurisdiction  over  such  school  the  names  of  all 
pupils  who  have  not  furnished  health  certificates  as  provided  in 
the  preceding  section,  and  the  medical  inspector  shall  cause  such 
pupils  to  be  separately  and  carefully  examined  and  tested  to  ascer- 
tain whether  any  of  them  are  suffering  from  defective  sight  or 
hearing,  or  from  any  other  physical  disability  tending  to  prevent 

138 


them  from  receiving  the  full  benefit  of  school  work,  or  requiring 
a  modification  of  such  work  to  prevent  injury  to  the  pupils  or  to 
receive  the  best  educational  results.  If  it  be  ascertained  upon 
such  tests  or  examination  that  any  of  such  pupils  are  inflicted* 
with  defective  sight  or  hearing  or  other  physical  disability  as  above 
described  the  principal  or  teacher,  having  charge  of  such  school, 
shall  notify  the  parents  or  other  persons  with  whom  such  pupils 
are  living,  as  to  the  existence  of  such  defects  and  physical  disability. 
If  the  parents  or  guardians  are  unable  or  unwilling  to  provide 
the  necessary  relief  and  treatment  for  such  pupils,  such  fact  shall 
be  reported  by  the  principal  or  teacher  to  the  medical  inspector, 
whose  duty  it  shall  be  to  provide  relief  for  such  pupils.  [Added  by 
L.  1913,  ch.  627.] 

§  574  RECORD  OF  EXAMINATIONS;  EYE  AND  EAR  TESTS.  Medical 
inspectors  or  principals  and  teachers  in  charge  of  public  schools 
shall  make  eye  and  ear  tests  of  the  pupils  in  such  schools,  at  least 
once  in  each  school  year.  The  State  Commissioner  of  Health 
shall  prescribe  the  method  of  making  such  tests,  and  shall  furnish 
general  instruction  in  respect  to  such  tests.  The  Commissioner  of 
Education,  after  consultation  with  the  State  Commissioner  of 
Health,  shall  prescribe  and  furnish  to  the  school  authorities  suit- 
able rules  of  instruction  as  to  tests  and  examinations  made  as  pro- 
vided in  this  article,  together  with  test  cards,  blanks,  record  books 
and  other  useful  appliances  for  carrying  out  the  purposes  of  this 
article.  The  Commissioner  of  Education  shall  provide  for  pupils 
in  the  normal  schools,  city  training  schools  and  training  classes 
instruction  and  practice  in  the  best  methods  of  testing  the  sight 
and  hearing  of  children.  [Added  by  L.  1913,  ch.  627.] 

§  575  EXISTENCE  OF  CONTAGIOUS  DISEASES;  RETURN  AFTER  ILL- 
NESS. Whenever  upon  investigation  a  pupil  in  the  public  schools 
shows  symptoms  of  smallpox,  scarlet  fever,  measles,  chicken  pox, 
tuberculosis,  diphtheria,  influenza,  tonsillitis,  whooping  cough, 
mumps,  scabies  or  trachoma,  he  shall  be  excluded  from  the  school 
and  sent  to  his  home  immediately,  in  a  safe  and  proper  convey- 
ance, and  the  health  officer  of  the  city  or  town  shall  be  imme- 
diately notified  of  the  existence  of  such  disease.  The  medical 
inspector  shall  examine  each  pupil  returning  to  a  school  without 
a  certificate  from  the  health  officer  of  the  city  or  town,  or  the 

*  So  in  original. 

139 


family  physician,  after  absence  on  account  of  illness  or  from  un- 
known cause. 

Such  medical  inspectors  may  make  such  examinations  of 
teachers,  janitors  and  school  buildings  as  in  their  opinion  the 
protection  of  the  health  of  the  pupils  and  teachers  may  require. 
[Added  by  L.  1913,  ch.  627.] 

§  576  ENFORCEMENT  OF  LAW.  It  shall  be  the  duty  of  the  Com- 
missioner of  Education  to  enforce  the  provisions  of  this  article, 
and  he  may  adopt  such  rules  and  regulations  not  inconsistent  here- 
with, after  consultation  with  the  State  Commissioner  of  Health, 
for  the  purpose  of  carrying  into  full  force  and  effect  the  objects 
and  intent  of  this  article. 

He  may,  in  his  discretion,  withhold  the  public  money  from  a 
district  which  wilfully  refuses  or  neglects  to  comply  with  this 
article,  and  the  rules  and  regulations  made  hereunder.  [Added 
by  L.  1913,  ch.  627.] 

§  577  STATE  MEDICAL  INSPECTOR  OF  SCHOOLS.  The  Commis- 
sioner of  Education  shall  appoint  a  competent  physician  who  has 
been  in  the  actual  practice  of  his  profession  for  a  period  of  at  least 
five  years,  as  state  medical  inspector  of  schools.  The  state  medical 
inspector  of  schools,  under  the  supervision  of  the  Commissioner 
of  Education,  shall  perform  such  duties  as  may  be  required  for 
carrying  out  the  provisions  of  this  article.  The  said  medical 
inspector  shall  be  appointed  in  the  same  manner  as  other  em- 
ployees of  the  Education  Department.  [Added  by  L.  1913, 
ch.  627.] 


140 


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